Healthcare Provider Details

I. General information

NPI: 1114508090
Provider Name (Legal Business Name): ESTHER OWUOR LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BRADSTON ST
BOSTON MA
02118-2703
US

IV. Provider business mailing address

23 BRADSTON ST
BOSTON MA
02118-2703
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-6480
  • Fax:
Mailing address:
  • Phone: 617-318-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN86448
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: