Provider Demographics
NPI:1801309067
Name:MARAGH, KETACHA JUSTINE (RN)
Entity type:Individual
Prefix:
First Name:KETACHA
Middle Name:JUSTINE
Last Name:MARAGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 NUTMEG DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1249
Mailing Address - Country:US
Mailing Address - Phone:508-762-6517
Mailing Address - Fax:
Practice Address - Street 1:53 NUTMEG DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1249
Practice Address - Country:US
Practice Address - Phone:508-762-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2285114163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse