Individual
TIGIST TADESSE FIYISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5650 UPPER 179TH ST W # NA, LAKEVILLE, MN 55044-4930
(651) 235-8272
Mailing address
5650 UPPER 179TH ST W # NA, LAKEVILLE, MN 55044-4930
(651) 235-8272
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2475789
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2475789
REGISTERED NURSE LICENSE NUMBER
MN
Enumeration date
10/21/2021
Last updated
10/21/2021
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