Provider Demographics
NPI:1164113148
Name:JARSO, MALICH DAWIT
Entity Type:Individual
Prefix:MR
First Name:MALICH
Middle Name:DAWIT
Last Name:JARSO
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 1:1002 BELSLY BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5017
Mailing Address - Country:US
Mailing Address - Phone:701-200-3143
Mailing Address - Fax:
Practice Address - Street 1:1002 BELSLY BLVD APT 203
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5017
Practice Address - Country:US
Practice Address - Phone:701-200-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant