Healthcare Provider Details

I. General information

NPI: 1013420272
Provider Name (Legal Business Name): GEORGE NJOROGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 POND ST
GEORGETOWN MA
01833-1638
US

IV. Provider business mailing address

43 POND ST
GEORGETOWN MA
01833-1638
US

V. Phone/Fax

Practice location:
  • Phone: 978-390-1950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2281322
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: