MEDICARE: RACHEAL KIBUKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2331554	MA

General Provider Information

NPI Number	:	1457214785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEAL KIBUKA

Provider Business Mailing Address
First Line	:	80 MAPLE ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3143
Country	:	US
Telephone Number	:	857-230-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 MAPLE ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3143
Country	:	US
Telephone Number	:	857-230-8630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ RACHEAL KIBUKA ” Practice Location

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