Individual
MISS HENRIETTA IMADE IDUMWONYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN, RN
Contact information
Practice address
66 CANAL ST, BOSTON, MA 02114-2002
(617) 371-3000
Mailing address
301 CENTRAL ST, AVON, MA 02322-1532
(617) 749-6062
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN2330913
MA
Other
Enumeration date
03/19/2019
Last updated
03/19/2019
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