Provider Demographics
NPI:1922567361
Name:AGEDEW, MEAZA
Entity Type:Individual
Prefix:
First Name:MEAZA
Middle Name:
Last Name:AGEDEW
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 1:12303 PLANO RD APT 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5316
Mailing Address - Country:US
Mailing Address - Phone:214-404-5273
Mailing Address - Fax:
Practice Address - Street 1:12303 PLANO RD APT 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5316
Practice Address - Country:US
Practice Address - Phone:214-404-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX917091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse