Provider Demographics
NPI:1114235157
Name:TESHOME, HELINA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:HELINA
Middle Name:
Last Name:TESHOME
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MARIACHI CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1935
Mailing Address - Country:US
Mailing Address - Phone:512-203-6264
Mailing Address - Fax:
Practice Address - Street 1:1901 MARIACHI CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1935
Practice Address - Country:US
Practice Address - Phone:512-203-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX716143163W00000X
TX11125548163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse