Individual
ELIAS MBOGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
200 SPRINGS RD, BEDFORD, MA 01730-1114
(781) 687-3872
Mailing address
151 B ST, DRACUT, MA 01826-2153
(781) 228-1513
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN94430
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LN94430
NURSING LICENSE
MA
Enumeration date
10/19/2020
Last updated
10/19/2020
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