Provider Demographics
NPI:1720752728
Name:TOLESSA, BEEKAM TEMESGEN (FNP)
Entity Type:Individual
Prefix:MR
First Name:BEEKAM
Middle Name:TEMESGEN
Last Name:TOLESSA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 COUNTY ROAD D W APT 218
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7539
Mailing Address - Country:US
Mailing Address - Phone:757-401-2817
Mailing Address - Fax:
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3791
Practice Address - Country:US
Practice Address - Phone:757-401-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily