Provider Demographics
NPI:1114752011
Name:KIGOTHO, MARY (BSN RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KIGOTHO
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 EMERSON CIR
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1498
Mailing Address - Country:US
Mailing Address - Phone:978-328-8541
Mailing Address - Fax:
Practice Address - Street 1:27 EMERSON CIR
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463-1498
Practice Address - Country:US
Practice Address - Phone:978-328-8541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2305807163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse