Healthcare Provider Details

I. General information

NPI: 1457292997
Provider Name (Legal Business Name): WINNIE NYACHIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 MAIN ST APT 11
MALDEN MA
02148-1443
US

IV. Provider business mailing address

1058 MAIN ST APT 11
MALDEN MA
02148-1443
US

V. Phone/Fax

Practice location:
  • Phone: 617-487-9540
  • Fax:
Mailing address:
  • Phone: 617-487-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2348627
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: