Provider Demographics
NPI:1982244075
Name:MIRITI, TONY MUTUGI (RN)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:MUTUGI
Last Name:MIRITI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2720
Mailing Address - Country:US
Mailing Address - Phone:978-728-7392
Mailing Address - Fax:
Practice Address - Street 1:119 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2720
Practice Address - Country:US
Practice Address - Phone:978-728-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2323890163WH0200X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health