Provider Demographics
NPI:1710859228
Name:JONAS, NYANDWI
Entity type:Individual
Prefix:
First Name:NYANDWI
Middle Name:
Last Name:JONAS
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 1:9211 E PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2912
Mailing Address - Country:US
Mailing Address - Phone:520-331-5109
Mailing Address - Fax:
Practice Address - Street 1:9211 E PATRICK DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2912
Practice Address - Country:US
Practice Address - Phone:520-331-5109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06093613172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty