MEDICARE: JEREMIAH NYAMACHE

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	106S00000X	Behavior Technician		MN

General Provider Information

NPI Number	:	1780512178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH NYAMACHE

Provider Business Mailing Address
First Line	:	9695 281ST AVE NE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6417
Country	:	US
Telephone Number	:	612-741-6392
Fax Number	:

Provider Business Practice Location Address
First Line	:	9695 281ST AVE NE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6417
Country	:	US
Telephone Number	:	612-741-6392
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ JEREMIAH NYAMACHE ” Practice Location

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