Provider Demographics
NPI:1770374977
Name:MUNYANEZA, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MUNYANEZA
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 1:417 ARBORETUM WAY
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8379
Mailing Address - Country:US
Mailing Address - Phone:331-454-3884
Mailing Address - Fax:
Practice Address - Street 1:500 WILCOX ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6188
Practice Address - Country:US
Practice Address - Phone:800-735-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program