1073405239 NPI number — MRS. ROSELINE MADUKA IHESIENE RN

Table of content: MRS. ROSELINE MADUKA IHESIENE RN (NPI 1073405239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073405239 NPI number — MRS. ROSELINE MADUKA IHESIENE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IHESIENE
Provider First Name:
ROSELINE
Provider Middle Name:
MADUKA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MADUKA
Provider Other First Name:
ROSELINE
Provider Other Middle Name:
CHUKWU
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073405239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
442 SAMUEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITINSVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01588-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-578-2899
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
442 SAMUEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITINSVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01588-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-578-2899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  2315532 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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