Provider Demographics
NPI:1619717915
Name:MATOVU, JANE NABISERE (RN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:NABISERE
Last Name:MATOVU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:NABISERE
Other - Last Name:MATOVU
Other - Suffix:X
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:3 SARAHS WAY
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4948
Mailing Address - Country:US
Mailing Address - Phone:865-406-1647
Mailing Address - Fax:
Practice Address - Street 1:3 SARAHS WAY
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4948
Practice Address - Country:US
Practice Address - Phone:865-406-1647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2375953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse