Provider Demographics
NPI:1275245748
Name:VYIZIGIRO, JEROME M
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:VYIZIGIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11735 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-9520
Mailing Address - Country:US
Mailing Address - Phone:515-525-4229
Mailing Address - Fax:
Practice Address - Street 1:320 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4350
Practice Address - Country:US
Practice Address - Phone:515-745-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171W00000XOther Service ProvidersContractor