Individual
KIDIST FISSEHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1633 W INNOVATION WAY FL 4, LEHI, UT 84043-4252
(855) 726-6363
(801) 784-1482
Mailing address
1633 W INNOVATION WAY FL 4, LEHI, UT 84043-4252
(855) 726-6363
(801) 784-1482
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1009883
TX
363LF0000X
Family Nurse Practitioner
Primary
9115682-4405
UT
Other
Enumeration date
05/19/2023
Last updated
07/25/2024
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