Individual
DAMARIS W KONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
39 ALLISON LN, LUDLOW, MA 01056-9201
(413) 530-7318
Mailing address
39 ALLISON LN, LUDLOW, MA 01056-9201
(413) 530-7318
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN270089
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN270089
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000000
SOCIAL SECURITY
MA
01
—
S31366290
DRIVERS LISENCE
MA
Enumeration date
07/03/2021
Last updated
01/27/2024
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