Provider Demographics
NPI:1225705304
Name:LEMLEM, HAIMANOT TEKELU
Entity Type:Individual
Prefix:
First Name:HAIMANOT
Middle Name:TEKELU
Last Name:LEMLEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20804 BELLERIVE DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7923
Mailing Address - Country:US
Mailing Address - Phone:512-576-4542
Mailing Address - Fax:
Practice Address - Street 1:20804 BELLERIVE DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-7923
Practice Address - Country:US
Practice Address - Phone:512-576-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26277520172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver