Provider Demographics
NPI:1962654939
Name:ZEWDE, TIGIST (RN, PHN II)
Entity Type:Individual
Prefix:MS
First Name:TIGIST
Middle Name:
Last Name:ZEWDE
Suffix:
Gender:F
Credentials:RN, PHN II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204-2052
Mailing Address - Country:US
Mailing Address - Phone:513-357-2808
Mailing Address - Fax:
Practice Address - Street 1:2136 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45204-2052
Practice Address - Country:US
Practice Address - Phone:513-357-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 292068163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0502834Medicaid
OH0580027Medicaid