Provider Demographics
NPI:1457167231
Name:NAMULWANA, JUSTINE (RN)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:NAMULWANA
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 1:8 GREENVIEW ST APT 104
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4605
Mailing Address - Country:US
Mailing Address - Phone:857-312-9524
Mailing Address - Fax:
Practice Address - Street 1:8 GREENVIEW ST APT 104
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4605
Practice Address - Country:US
Practice Address - Phone:857-312-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10015675163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse