Healthcare Provider Details

I. General information

NPI: 1336075241
Provider Name (Legal Business Name): PAULINE NABACWA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 JACKSON ST APT 416
LOWELL MA
01852-2145
US

IV. Provider business mailing address

27 JACKSON ST APT 416
LOWELL MA
01852-2145
US

V. Phone/Fax

Practice location:
  • Phone: 857-287-5090
  • Fax:
Mailing address:
  • Phone: 857-287-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN1002413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: