1134454804 NPI number — MR. GEORGE MUIGAI KIONGERA RN., GNP-BC., NP-C

Table of content: MR. GEORGE MUIGAI KIONGERA RN., GNP-BC., NP-C (NPI 1134454804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134454804 NPI number — MR. GEORGE MUIGAI KIONGERA RN., GNP-BC., NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIONGERA
Provider First Name:
GEORGE
Provider Middle Name:
MUIGAI
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN., GNP-BC., NP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134454804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
439 S UNION ST
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843-2844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-452-4254
Provider Business Mailing Address Fax Number:
978-452-4254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
439 S UNION ST
Provider Second Line Business Practice Location Address:
BUILDING 2, SUITE 107
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01843-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-794-1158
Provider Business Practice Location Address Fax Number:
978-794-1507
Provider Enumeration Date:
10/13/2009

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  266371 , 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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