Provider Demographics
NPI:1962248625
Name:NZAYINAMBAHO, DUSHIME
Entity type:Individual
Prefix:
First Name:DUSHIME
Middle Name:
Last Name:NZAYINAMBAHO
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 1:2506 NORMANDY DR SE APT 206B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-7904
Mailing Address - Country:US
Mailing Address - Phone:616-299-0969
Mailing Address - Fax:
Practice Address - Street 1:2506 NORMANDY DR SE APT 206B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-7904
Practice Address - Country:US
Practice Address - Phone:616-299-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI803236597343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)