Provider Demographics
NPI:1982104766
Name:TEKLHAIMANOT, ZAID KAHSSAY
Entity Type:Individual
Prefix:
First Name:ZAID
Middle Name:KAHSSAY
Last Name:TEKLHAIMANOT
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 1:12250 S KIRKWOOD RD APT 312
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2119
Mailing Address - Country:US
Mailing Address - Phone:956-655-5762
Mailing Address - Fax:
Practice Address - Street 1:12250 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2117
Practice Address - Country:US
Practice Address - Phone:956-655-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX795147163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse