Individual
FEYISSA JAFAR WAGESSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2468 BRENNER AVE E, MAPLEWOOD, MN 55109-1573
(763) 910-7300
(218) 979-7692
Mailing address
2468 BRENNER AVE E, MAPLEWOOD, MN 55109-1573
(763) 910-7300
(218) 979-7692
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A636435500
—
MN
Enumeration date
07/03/2024
Last updated
08/08/2025
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