Provider Demographics
NPI:1235494030
Name:RUTASHONGERWA, GEORGE FIDELIS
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:FIDELIS
Last Name:RUTASHONGERWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:FIDELIS
Other - Last Name:RUTASHONGERWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:230 SANTA MONICA DR
Mailing Address - Street 2:APT C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6667
Mailing Address - Country:US
Mailing Address - Phone:614-254-9609
Mailing Address - Fax:
Practice Address - Street 1:230 SANTA MONICA DR
Practice Address - Street 2:APT C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6667
Practice Address - Country:US
Practice Address - Phone:614-254-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-345908163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse