Provider Demographics
NPI:1578710323
Name:TESFAI, BISRAT G (NURSE LVN)
Entity Type:Individual
Prefix:MRS
First Name:BISRAT
Middle Name:G
Last Name:TESFAI
Suffix:
Gender:F
Credentials:NURSE LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 MORNING BROOK LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8715
Mailing Address - Country:US
Mailing Address - Phone:208-835-7696
Mailing Address - Fax:
Practice Address - Street 1:1274 CITY VIEW PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-4333
Practice Address - Country:US
Practice Address - Phone:408-254-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 155621164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse