Provider Demographics
NPI:1689392441
Name:ERIC, MANIRAKIZA
Entity Type:Individual
Prefix:
First Name:MANIRAKIZA
Middle Name:
Last Name:ERIC
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 1:2655 S 34TH ST APT 115
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6515
Mailing Address - Country:US
Mailing Address - Phone:701-885-2645
Mailing Address - Fax:701-922-0776
Practice Address - Street 1:2655 S 34TH ST APT 115
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6515
Practice Address - Country:US
Practice Address - Phone:701-885-2645
Practice Address - Fax:701-922-0776
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant