Provider Demographics
NPI:1649143488
Name:NDATABAYE, INNOCENT RUGABISHA
Entity type:Individual
Prefix:
First Name:INNOCENT
Middle Name:RUGABISHA
Last Name:NDATABAYE
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 1:612 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4713
Mailing Address - Country:US
Mailing Address - Phone:270-784-0031
Mailing Address - Fax:
Practice Address - Street 1:612 N 19TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4713
Practice Address - Country:US
Practice Address - Phone:270-784-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care