MEDICARE: INNOCENT NSENGIYUMVA

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	363A00000X	Physician Assistant	PAC1203	ND
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1285324483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNOCENT NSENGIYUMVA

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 UNIVERSITY DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-4940
Country	:	US
Telephone Number	:	701-417-6000
Fax Number	:

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

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	01/16/2026

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Directions to “ INNOCENT NSENGIYUMVA ” Practice Location

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