Individual
MOLLY N/A NAKIBERU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
211 BROOKFIELD RD, STURBRIDGE, MA 01518-1024
(508) 218-9602
Mailing address
211 BROOKFIELD RD, STURBRIDGE, MA 01518-1024
(508) 215-9602
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN88641
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1869
—
MA
Enumeration date
12/19/2022
Last updated
12/19/2022
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