Individual
MR. BLAISE ISHIMWE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DSP
Contact information
Practice address
3 COBALT CT # PVT, WINDHAM, ME 04062-4691
(225) 284-6850
Mailing address
3 COBALT CT # PVT, WINDHAM, ME 04062-4691
(225) 284-6850
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
10/20/2020
Last updated
10/20/2020
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