Provider Demographics
NPI:1811765043
Name:MUSABYIMANA, JEAN DE DIEU
Entity type:Individual
Prefix:MR
First Name:JEAN DE DIEU
Middle Name:
Last Name:MUSABYIMANA
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 1:6841 ASHWOOD RD APT 201
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1281
Mailing Address - Country:US
Mailing Address - Phone:701-595-9237
Mailing Address - Fax:
Practice Address - Street 1:6841 ASHWOOD RD APT 201
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1281
Practice Address - Country:US
Practice Address - Phone:701-595-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver