Provider Demographics
NPI:1205514007
Name:TESMAMA, ADDISALEM (NP)
Entity type:Individual
Prefix:
First Name:ADDISALEM
Middle Name:
Last Name:TESMAMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 VALLEY VIEW LN, DALLAS, TX 75244
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5071
Mailing Address - Country:US
Mailing Address - Phone:855-984-5121
Mailing Address - Fax:
Practice Address - Street 1:8230 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2200
Practice Address - Country:US
Practice Address - Phone:513-891-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0034048363LF0000X
KY4006538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily