KIDIST FISSEHA

SLC, UT
NPI1356032262
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: UT  9115682-4405)
Additional Taxonomies163W00000X Registered Nurse
(Licence: TX  1009883)
Enumeration Date2023-05-19
Last Update Date2023-06-06
Business Address
KIDIST FISSEHA
250 E 200 S FL 16
SLC, UT 84111-2472
Phone number: 855-726-6363
Mailing Address
KIDIST FISSEHA
250 E 200 S FL 16
SLC, UT 84111-2472
Phone number: 855-726-6363