Provider Demographics
NPI:1588204978
Name:NYIRAMANA, SPECIOSE
Entity Type:Individual
Prefix:
First Name:SPECIOSE
Middle Name:
Last Name:NYIRAMANA
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 1:905 CREEKEDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4268
Mailing Address - Country:US
Mailing Address - Phone:270-599-6963
Mailing Address - Fax:
Practice Address - Street 1:905 CREEKEDGE CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-4268
Practice Address - Country:US
Practice Address - Phone:270-599-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN001067640OtherSOS CONTROL