Provider Demographics
NPI:1942039458
Name:MUKIZA, JOHNSON SERIEUX
Entity type:Individual
Prefix:
First Name:JOHNSON
Middle Name:SERIEUX
Last Name:MUKIZA
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 1:223 SIERRA PARK DR
Mailing Address - Street 2:
Mailing Address - City:HILLS
Mailing Address - State:IA
Mailing Address - Zip Code:52235-7756
Mailing Address - Country:US
Mailing Address - Phone:319-383-9411
Mailing Address - Fax:
Practice Address - Street 1:223 SIERRA PARK DR
Practice Address - Street 2:
Practice Address - City:HILLS
Practice Address - State:IA
Practice Address - Zip Code:52235-7756
Practice Address - Country:US
Practice Address - Phone:319-383-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty