Provider Demographics
NPI:1205677374
Name:SEREVAT, NSABIMANA
Entity type:Individual
Prefix:
First Name:NSABIMANA
Middle Name:
Last Name:SEREVAT
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 1:601 E SELTICE WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7638
Mailing Address - Country:US
Mailing Address - Phone:208-446-5914
Mailing Address - Fax:
Practice Address - Street 1:601 E SELTICE WAY STE 207
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7638
Practice Address - Country:US
Practice Address - Phone:208-446-5914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider