Provider Demographics
NPI:1811273949
Name:ADMASSU, MEZGEBUA TADESSE (LPN)
Entity type:Individual
Prefix:
First Name:MEZGEBUA
Middle Name:TADESSE
Last Name:ADMASSU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 S HAMILTON RD APT 50
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4003
Mailing Address - Country:US
Mailing Address - Phone:614-575-8566
Mailing Address - Fax:
Practice Address - Street 1:498 S. HAMILTON RD
Practice Address - Street 2:APT #50
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4003
Practice Address - Country:US
Practice Address - Phone:614-575-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN117786164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN117786OtherLPN
OH117786OtherLPN