Provider Demographics
NPI:1740918481
Name:KIVUMBI, ANNETTE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:KIVUMBI
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 1:39 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1632
Mailing Address - Country:US
Mailing Address - Phone:781-521-5633
Mailing Address - Fax:
Practice Address - Street 1:39 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1632
Practice Address - Country:US
Practice Address - Phone:781-521-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281358163W00000X, 163WC1500X, 163WG0000X, 163WH0200X, 163WH1000X, 163WP0809X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult