Provider Demographics
NPI:1205673407
Name:NDERITO, EPHRAIM
Entity type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:
Last Name:NDERITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ORKNEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-3525
Mailing Address - Country:US
Mailing Address - Phone:574-309-0377
Mailing Address - Fax:
Practice Address - Street 1:1515 ORKNEY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3525
Practice Address - Country:US
Practice Address - Phone:574-309-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program