Provider Demographics
NPI:1831444769
Name:KYAMIZA, LEONARD BYABONA (LPN)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:BYABONA
Last Name:KYAMIZA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BROADMEADOWS BLVD
Mailing Address - Street 2:APT 5473
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1153
Mailing Address - Country:US
Mailing Address - Phone:614-431-5142
Mailing Address - Fax:
Practice Address - Street 1:80 BROADMEADOWS BLVD
Practice Address - Street 2:APT 5473
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1153
Practice Address - Country:US
Practice Address - Phone:614-431-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.149308-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse