Provider Demographics
NPI:1891943114
Name:TAREKEGN, TESHOME (RN)
Entity Type:Individual
Prefix:MR
First Name:TESHOME
Middle Name:
Last Name:TAREKEGN
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 1:185 SKY OAKS DR
Mailing Address - Street 2:C/O RANDY HAUSTED
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-9627
Mailing Address - Country:US
Mailing Address - Phone:707-963-6288
Mailing Address - Fax:
Practice Address - Street 1:185 SKY OAKS DR
Practice Address - Street 2:C/O RANDY HAUSTED
Practice Address - City:ANGWIN
Practice Address - State:CA
Practice Address - Zip Code:94508-9627
Practice Address - Country:US
Practice Address - Phone:707-963-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse