Provider Demographics
NPI:1043488091
Name:KINTU, JANEPHER S
Entity type:Individual
Prefix:MISS
First Name:JANEPHER
Middle Name:S
Last Name:KINTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4416
Mailing Address - Country:US
Mailing Address - Phone:508-734-5359
Mailing Address - Fax:
Practice Address - Street 1:1225 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4416
Practice Address - Country:US
Practice Address - Phone:508-734-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X, 372600000X
MA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion