Healthcare Provider Details

I. General information

NPI: 1821992314
Provider Name (Legal Business Name): ALPHONSINE MUKOBWAJANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALPHONSINE ALPHA MUKOBWAJANA

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 OAKLAND AVE
AKRON OH
44310-1442
US

IV. Provider business mailing address

1052 OAKLAND AVE
AKRON OH
44310-1442
US

V. Phone/Fax

Practice location:
  • Phone: 234-349-0122
  • Fax:
Mailing address:
  • Phone: 234-349-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberVP766790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: