Provider Demographics
NPI:1215111760
Name:KINTU, ROSETTE NAMWANJE
Entity type:Individual
Prefix:MS
First Name:ROSETTE
Middle Name:NAMWANJE
Last Name:KINTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1793
Mailing Address - Country:US
Mailing Address - Phone:508-440-5752
Mailing Address - Fax:
Practice Address - Street 1:57 MEETINGHOUSE RD.
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1793
Practice Address - Country:US
Practice Address - Phone:508-440-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50095164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA200711200006OtherMASSHEALTH PROVIDER