MEDICARE: KUBWIMANA JEAN PAUL

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	3747P1801X	Personal Care Attendant		ND

General Provider Information

NPI Number	:	1588598270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUBWIMANA JEAN PAUL

Provider Business Mailing Address
First Line	:	1751 36TH AVE S APT 301
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7365
Country	:	US
Telephone Number	:	559-521-6743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 36TH AVE S APT 301
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7365
Country	:	US
Telephone Number	:	559-521-6743
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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