Provider Demographics
NPI:1942897723
Name:CHITIYO, KUZIWA ENEDIA
Entity Type:Individual
Prefix:MRS
First Name:KUZIWA
Middle Name:ENEDIA
Last Name:CHITIYO
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 1:177 10TH AVE E APT 35
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5440
Mailing Address - Country:US
Mailing Address - Phone:701-502-1053
Mailing Address - Fax:
Practice Address - Street 1:177 10TH AVE E APT 35
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5440
Practice Address - Country:US
Practice Address - Phone:701-690-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14708443747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant