Provider Demographics
NPI:1699384685
Name:NSHIMIYUMUKIZA, MARIE ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:MARIE ROSE
Middle Name:
Last Name:NSHIMIYUMUKIZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LENOX ST UNIT 142
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3694
Mailing Address - Country:US
Mailing Address - Phone:857-350-2296
Mailing Address - Fax:
Practice Address - Street 1:1290 TREMONT ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-3432
Practice Address - Country:US
Practice Address - Phone:617-858-2432
Practice Address - Fax:617-989-3054
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily