Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12011737A | IN |
NPI | 1093090318 |
---|---|
Provider Name | Dr. Claudette Umurerwa Munyabera |
First Address | Pueblo, CO 81003-3038 |
Second Address | Mishawaka, IN 46545-3012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2011 |
Last Update Date | 04/11/2011 |