Provider Demographics
NPI:1225812209
Name:MAMO, TSION SOLOMON (BSN FNP STUDENT)
Entity Type:Individual
Prefix:MRS
First Name:TSION
Middle Name:SOLOMON
Last Name:MAMO
Suffix:
Gender:F
Credentials:BSN FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 NACHAND LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2854
Mailing Address - Country:US
Mailing Address - Phone:571-225-2866
Mailing Address - Fax:
Practice Address - Street 1:2118 PORTLAND AVE
Practice Address - Street 2:FORMER EMPLOYER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212
Practice Address - Country:US
Practice Address - Phone:833-419-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1154534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse