Provider Demographics
NPI:1487410999
Name:MUTEGYEKI, KENNETH (RN BSN)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MUTEGYEKI
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 HAVEN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3821
Mailing Address - Country:US
Mailing Address - Phone:508-933-1804
Mailing Address - Fax:
Practice Address - Street 1:58 HAVEN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3821
Practice Address - Country:US
Practice Address - Phone:508-933-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267715163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health