Healthcare Provider Details

I. General information

NPI: 1669282042
Provider Name (Legal Business Name): JEANINE UWINEZA RUGAMBAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 METHODIST RD
WESTBROOK ME
04092-3201
US

IV. Provider business mailing address

9 METHODIST RD
WESTBROOK ME
04092-3201
US

V. Phone/Fax

Practice location:
  • Phone: 832-640-7085
  • Fax:
Mailing address:
  • Phone: 832-640-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: