Provider Demographics
NPI:1497414684
Name:NYIRENDA, MNJUZI DUNCAN (NP)
Entity Type:Individual
Prefix:
First Name:MNJUZI
Middle Name:DUNCAN
Last Name:NYIRENDA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 BALLYGANNER DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6948
Mailing Address - Country:US
Mailing Address - Phone:317-476-7057
Mailing Address - Fax:
Practice Address - Street 1:1725 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1403
Practice Address - Country:US
Practice Address - Phone:317-396-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28199770A363L00000X
IN71012778A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner