Provider Demographics
NPI:1336637131
Name:DENGITIE, DEJENE NEGASH SR
Entity Type:Individual
Prefix:MR
First Name:DEJENE
Middle Name:NEGASH
Last Name:DENGITIE
Suffix:SR
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 1:7401 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-2070
Mailing Address - Country:US
Mailing Address - Phone:214-909-5506
Mailing Address - Fax:
Practice Address - Street 1:7401 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-2070
Practice Address - Country:US
Practice Address - Phone:214-909-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX734946163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse