Provider Demographics
NPI:1770201915
Name:NALUKWAGO, KEZIAH CATHERINE
Entity type:Individual
Prefix:
First Name:KEZIAH
Middle Name:CATHERINE
Last Name:NALUKWAGO
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:NORTH SHORE COMMUNITY HEALTH
Mailing Address - Street 2:27 CONGRESS STREET, SUITE 513
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-825-1175
Mailing Address - Fax:
Practice Address - Street 1:NORTH SHORE COMMUNITY HEALTH
Practice Address - Street 2:27 CONGRESS STREET, SUITE 513
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-825-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2269765363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2269765Medicaid