Provider Demographics
NPI:1376357061
Name:BIENVENU, IRAKOZE MUTUNZI
Entity type:Individual
Prefix:
First Name:IRAKOZE
Middle Name:MUTUNZI
Last Name:BIENVENU
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 1:444 E BRANDON DR APT 9
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0498
Mailing Address - Country:US
Mailing Address - Phone:615-769-1308
Mailing Address - Fax:
Practice Address - Street 1:4816 MELLOWSUN DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-8857
Practice Address - Country:US
Practice Address - Phone:701-400-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant