Healthcare Provider Details

I. General information

NPI: 1538844956
Provider Name (Legal Business Name): VIVIAN MBAWUIKE RN-BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PINEWOOD ST
BOSTON MA
02136-6020
US

IV. Provider business mailing address

10 PINEWOOD ST
BOSTON MA
02136-6020
US

V. Phone/Fax

Practice location:
  • Phone: 857-251-0336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2322887
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN2322887
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2322887
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2322887
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2322887
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2322887
License Number StateMA
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberRN2322887
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: