Provider Demographics
NPI:1659618866
Name:DAGNE, TSELOT BELACHEW
Entity Type:Individual
Prefix:
First Name:TSELOT
Middle Name:BELACHEW
Last Name:DAGNE
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 1:1171 S CHESTER CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2379
Mailing Address - Country:US
Mailing Address - Phone:720-628-4728
Mailing Address - Fax:
Practice Address - Street 1:1171 S CHESTER CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2379
Practice Address - Country:US
Practice Address - Phone:720-628-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0048763164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse