Provider Demographics
NPI:1720323629
Name:NJURU, BEN M (LPN)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:M
Last Name:NJURU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 RIVERLIN ST
Mailing Address - Street 2:APT. # A
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-4142
Mailing Address - Country:US
Mailing Address - Phone:508-713-3572
Mailing Address - Fax:
Practice Address - Street 1:91 RIVERLIN ST
Practice Address - Street 2:APT. # A
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-4142
Practice Address - Country:US
Practice Address - Phone:508-713-3572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN64242164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse