Provider Demographics
NPI:1295592285
Name:WONDIMSISHA, BALNJER ASHEBIR
Entity type:Individual
Prefix:
First Name:BALNJER
Middle Name:ASHEBIR
Last Name:WONDIMSISHA
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 1:219 SUMMER GATE CT
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1794
Mailing Address - Country:US
Mailing Address - Phone:571-359-5787
Mailing Address - Fax:
Practice Address - Street 1:219 SUMMER GATE CT
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-1794
Practice Address - Country:US
Practice Address - Phone:571-359-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver