Healthcare Provider Details

I. General information

NPI: 1417561184
Provider Name (Legal Business Name): BINALFEW MENGISTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 08/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S NOME CT
AURORA CO
80014-8001
US

IV. Provider business mailing address

2250 S NOME CT
AURORA CO
80014
US

V. Phone/Fax

Practice location:
  • Phone: 720-277-4012
  • Fax:
Mailing address:
  • Phone: 720-277-4012
  • Fax: 303-731-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number04J235
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: