Provider Demographics
NPI:1538869102
Name:GITHIIRU, POLINE MERCY NJERI (ATTC)
Entity type:Individual
Prefix:MRS
First Name:POLINE
Middle Name:MERCY NJERI
Last Name:GITHIIRU
Suffix:
Gender:F
Credentials:ATTC
Other - Prefix:
Other - First Name:POLINE
Other - Middle Name:MERCY NJERI
Other - Last Name:GITHIIRU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2248 MAPLE STONE LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3835
Mailing Address - Country:US
Mailing Address - Phone:317-363-9966
Mailing Address - Fax:317-534-1196
Practice Address - Street 1:2248 MAPLE STONE LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3835
Practice Address - Country:US
Practice Address - Phone:317-363-9966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22-014722-1374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300038014Medicaid