Provider Demographics
NPI:1821818063
Name:MUGISHA, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MUGISHA
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 1:651 CARLISLE AVE # A
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2736
Mailing Address - Country:US
Mailing Address - Phone:716-541-5926
Mailing Address - Fax:
Practice Address - Street 1:651 CARLISLE AVE # A
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2736
Practice Address - Country:US
Practice Address - Phone:716-541-5926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty