Individual
ASSEFA DEGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9846 HWY 31 E, TYLER, TX 75705-2329
(903) 592-8001
Mailing address
9846 HWY 31 E, TYLER, TX 75705-2329
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
2096174
VA
Other
Enumeration date
08/13/2018
Last updated
08/13/2018
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