Provider Demographics
NPI:1255646642
Name:DAGNEW, TIGIST (RN)
Entity type:Individual
Prefix:
First Name:TIGIST
Middle Name:
Last Name:DAGNEW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8754 GREYLAG LOOP
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8332
Mailing Address - Country:US
Mailing Address - Phone:614-565-2616
Mailing Address - Fax:
Practice Address - Street 1:8754 GREYLAG LOOP
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8332
Practice Address - Country:US
Practice Address - Phone:614-565-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN331702163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management