Provider Demographics
NPI:1255873931
Name:KIFLOM, BETHLEHEM
Entity type:Individual
Prefix:
First Name:BETHLEHEM
Middle Name:
Last Name:KIFLOM
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 1:1800 GRAHAM AVE UNIT 330
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1371
Mailing Address - Country:US
Mailing Address - Phone:612-229-8969
Mailing Address - Fax:
Practice Address - Street 1:1800 GRAHAM AVE UNIT 330
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1371
Practice Address - Country:US
Practice Address - Phone:612-229-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN222598-0163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health