Provider Demographics
NPI:1083430094
Name:MUNDELE-MASSAMBA, COLETTE (RN)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:MUNDELE-MASSAMBA
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 1:9 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7939
Mailing Address - Country:US
Mailing Address - Phone:781-526-0447
Mailing Address - Fax:877-730-4739
Practice Address - Street 1:9 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7939
Practice Address - Country:US
Practice Address - Phone:781-526-0447
Practice Address - Fax:877-730-4739
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9645826163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management