Basic Information
Provider Information
NPI: 1275091449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: UWIMANA
FirstName: SYLVIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 APPLE BLOSSOM DR
Address2:  
City: ABILENE
State: TX
PostalCode: 796026006
CountryCode: US
TelephoneNumber: 3253202887
FaxNumber:  
Practice Location
Address1: 4601 S 14TH ST
Address2:  
City: ABILENE
State: TX
PostalCode: 796054734
CountryCode: US
TelephoneNumber: 3256696552
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/06/2019
LastUpdateDate: 03/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-18-58389TXY    

No ID Information.


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