Provider Demographics
NPI:1336904242
Name:TEGENE, YESHIMEBET
Entity Type:Individual
Prefix:
First Name:YESHIMEBET
Middle Name:
Last Name:TEGENE
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 1:1188 S RIFLE CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4224
Mailing Address - Country:US
Mailing Address - Phone:720-934-1065
Mailing Address - Fax:
Practice Address - Street 1:2306 ZANE PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1651
Practice Address - Country:US
Practice Address - Phone:720-934-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO013230172342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company