Provider Demographics
NPI:1376954040
Name:TSEGAYE, ADDIS G (RN)
Entity Type:Individual
Prefix:
First Name:ADDIS
Middle Name:G
Last Name:TSEGAYE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 AUSTRIAN WAY
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5626
Mailing Address - Country:US
Mailing Address - Phone:614-556-5424
Mailing Address - Fax:
Practice Address - Street 1:7129 AUSTRIAN WAY
Practice Address - Street 2:APT/SUITE
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5626
Practice Address - Country:US
Practice Address - Phone:614-556-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH378012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse