MEDICARE: JOSIANE NYIRASHOMBO APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP0041645	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	921312792	OTHER	OH	HEALTH PARTNERS

General Provider Information

NPI Number	:	1609580109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIANE NYIRASHOMBO APRN

Provider Business Mailing Address
First Line	:	12 W WENGER RD STE J
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-287-9106
Fax Number	:	937-518-6671

Provider Business Practice Location Address
First Line	:	12 W WENGER RD STE J
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2755
Country	:	US
Telephone Number	:	937-287-9201
Fax Number	:

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

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	04/08/2026

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