Individual
AYANTU G/MEDHIN BEKUTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3309 W 132ND ST, BURNSVILLE, MN 55337-1878
(651) 431-1892
Mailing address
3309 W 132ND ST, BURNSVILLE, MN 55337-1878
(651) 431-1892
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
1109755
MN
253Z00000X
In Home Supportive Care Agency
1109755
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1109755
INDIVIDUAL PROVIDER
MN
Enumeration date
08/26/2022
Last updated
08/30/2022
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