Healthcare Provider Details

I. General information

NPI: 1013872548
Provider Name (Legal Business Name): CAROLINE W MWANIKI REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMBRIDGE ST
CAMBRIDGE MA
02141-1001
US

IV. Provider business mailing address

950 CAMBRIDGE ST
CAMBRIDGE MA
02141-1001
US

V. Phone/Fax

Practice location:
  • Phone: 617-441-1800
  • Fax:
Mailing address:
  • Phone: 617-441-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2345698
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: