Provider Demographics
NPI:1104457258
Name:MASEMBE, HENRY
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:MASEMBE
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 1:270 LAWRENCE ST APT 18
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3593
Mailing Address - Country:US
Mailing Address - Phone:781-354-0593
Mailing Address - Fax:
Practice Address - Street 1:270 LAWRENCE ST APT 18
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-3593
Practice Address - Country:US
Practice Address - Phone:781-354-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN98177164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse