Provider Demographics
NPI:1528327756
Name:TWIZERNMUKIZA, JEAN BAPTISTE
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:BAPTISTE
Last Name:TWIZERNMUKIZA
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 1:2239 24TH ST APT 15
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-4562
Mailing Address - Country:US
Mailing Address - Phone:309-631-4171
Mailing Address - Fax:
Practice Address - Street 1:2239 24TH ST APT 15
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-4562
Practice Address - Country:US
Practice Address - Phone:309-631-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter