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General NPI Number Information
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NPI Number | 1902442874
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Entity Type | Individual
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Provider Name | RAISSA MUTUYIMANA NP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 300 QUAKER LN # C2-4
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City | WARWICK
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State | RI
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Zip | 02886-0159
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Country | US
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Telephone | 401-233-5051
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Fax | 401-372-3445
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Provider Business Mailing Address
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Address Line | 30 W MONROE ST STE 1200
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City | CHICAGO
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State | IL
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Zip | 60603-2420
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP021157
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License Number State | PA
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