MEDICARE: CONSOLEE NYIRAMANA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2055X	Child Mental Illness Respite Care	11283764	AZ

General Provider Information

NPI Number	:	1124764907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSOLEE NYIRAMANA

Provider Business Mailing Address
First Line	:	4000 N CENTRAL AVE STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-3520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11024 N 28TH DR STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4378
Country	:	US
Telephone Number	:	602-944-6222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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Directions to “ CONSOLEE NYIRAMANA ” Practice Location

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