Individual
ENNETTE S TAWAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, MSN,RN
Contact information
Practice address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
Mailing address
39 BELCOURT RD, WORCESTER, MA 01605-2301
(508) 308-2926
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2269766
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110022061B
GROUP MEDICAID
MA
Enumeration date
05/02/2011
Last updated
05/02/2011
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