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General NPI Number Information
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NPI Number | 1710878152
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Entity Type | Individual
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Provider Name | RONALD KIMBUGWE
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Gender | Male
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 56 PAWTUCKET BLVD
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City | TYNGSBORO
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State | MA
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Zip | 01879-1592
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Country | US
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Telephone | 781-658-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 56 PAWTUCKET BLVD
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City | TYNGSBORO
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State | MA
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Zip | 01879-1592
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Country | US
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Telephone | 781-658-0041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LN102218
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LN1O2218
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License Number State | MA
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