Provider Demographics
NPI:1508673054
Name:AMUWUM, NADEGE M
Entity type:Individual
Prefix:
First Name:NADEGE
Middle Name:M
Last Name:AMUWUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4364
Mailing Address - Country:US
Mailing Address - Phone:773-961-5809
Mailing Address - Fax:
Practice Address - Street 1:58 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4364
Practice Address - Country:US
Practice Address - Phone:773-961-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAT701374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide