Individual
EBISE BAYISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12457 MIDWAY CIR NE, BLAINE, MN 55449-6228
(612) 423-5057
Mailing address
12457 MIDWAY CIR NE, BLAINE, MN 55449-6228
Taxonomy
Speciality
Code
Description
License number
State
385HR2065X
Child Physical Disabilities Respite Care
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
612653119
—
MN
Enumeration date
03/23/2021
Last updated
03/23/2021
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