Healthcare Provider Details

I. General information

NPI: 1043537830
Provider Name (Legal Business Name): ANNIE WAITHERA GATHERU R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SUNDERLAND RD
WORCESTER MA
01604-2046
US

IV. Provider business mailing address

425 SUNDERLAND RD
WORCESTER MA
01604-2046
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-0889
  • Fax: 508-363-0885
Mailing address:
  • Phone: 508-363-0889
  • Fax: 508-363-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2264630
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: