Individual
DIANA SENGOOBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
356 LINCOLN ST APT 4, WALTHAM, MA 02451-2139
(617) 606-1716
Mailing address
356 LINCOLN ST APT 4, WALTHAM, MA 02451-2139
(617) 606-1716
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN87810
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05
—
MA
Enumeration date
03/05/2018
Last updated
03/05/2018
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