Provider Demographics
NPI:1750742177
Name:MBABAZI, JANE
Entity type:Individual
Prefix:MISS
First Name:JANE
Middle Name:
Last Name:MBABAZI
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 1:1223 ARBORETUM WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3838
Mailing Address - Country:US
Mailing Address - Phone:978-855-3168
Mailing Address - Fax:781-652-9592
Practice Address - Street 1:1223 ARBORETUM WAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3838
Practice Address - Country:US
Practice Address - Phone:978-855-3168
Practice Address - Fax:781-652-9592
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89843164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse