Provider Demographics
NPI:1841622321
Name:MUTITU, FREDRICK MWATHI
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:MWATHI
Last Name:MUTITU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BENEFIT ST
Mailing Address - Street 2:APT. 1 L
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1551
Mailing Address - Country:US
Mailing Address - Phone:774-253-3494
Mailing Address - Fax:
Practice Address - Street 1:16 BENEFIT ST
Practice Address - Street 2:APT. 1 L
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1551
Practice Address - Country:US
Practice Address - Phone:774-253-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN87206164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse