Provider Demographics
NPI:1588484307
Name:MUKISA, JULIUS RONALD
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:RONALD
Last Name:MUKISA
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 1:22 OLD COUNTY RD
Mailing Address - Street 2:UNIT A2
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952
Mailing Address - Country:US
Mailing Address - Phone:978-891-0089
Mailing Address - Fax:
Practice Address - Street 1:22 OLD COUNTY RD UNIT A-2
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-2335
Practice Address - Country:US
Practice Address - Phone:978-891-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN100868164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty