Provider Demographics
NPI:1508557745
Name:NIYONSABA, DIEUDONNE
Entity Type:Individual
Prefix:
First Name:DIEUDONNE
Middle Name:
Last Name:NIYONSABA
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 1:315 PINE ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6369
Mailing Address - Country:US
Mailing Address - Phone:207-312-8232
Mailing Address - Fax:
Practice Address - Street 1:315 PINE ST APT 1F
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6369
Practice Address - Country:US
Practice Address - Phone:207-312-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities