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Individual

OSWARLD NIYIDUHA IRAKUNDA RUSIBAMAYILA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1500 W NORTHMOOR RD, PEORIA, IL 61614-3435
(309) 691-2200
Mailing address
7345 WOODLAND DR STE D, INDIANAPOLIS, IN 46278-1737
(317) 286-2885
(317) 536-3097

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041405733
IL
163W00000X
Registered Nurse
893242
TX
163W00000X
Registered Nurse
RN273461
GA

Other

Enumeration date
01/03/2018
Last updated
01/03/2018
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