Provider Demographics
NPI:1144566258
Name:JEBESSA, ZENE TESHOME (RN)
Entity Type:Individual
Prefix:
First Name:ZENE
Middle Name:TESHOME
Last Name:JEBESSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2587
Mailing Address - Country:US
Mailing Address - Phone:320-587-5162
Mailing Address - Fax:
Practice Address - Street 1:246 MAIN ST S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2587
Practice Address - Country:US
Practice Address - Phone:320-587-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 209071-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse