| NPI | 1609184019 | 
|---|---|
| Former Name | TSEGANESH HAILU | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: MN R147517-1) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN R 147517-1) | 
| Enumeration Date | 2010-09-20 | 
| Last Update Date | 2010-09-20 |