Provider Demographics
NPI:1881441707
Name:GIKUNDIRO, ESPERANCE
Entity type:Individual
Prefix:
First Name:ESPERANCE
Middle Name:
Last Name:GIKUNDIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 REDBLUFF DR APT 9
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3123
Mailing Address - Country:US
Mailing Address - Phone:937-607-4749
Mailing Address - Fax:
Practice Address - Street 1:1341 REDBLUFF DR APT 9
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3123
Practice Address - Country:US
Practice Address - Phone:937-607-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUJ626696343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)