Healthcare Provider Details

I. General information

NPI: 1295257756
Provider Name (Legal Business Name): BANCHI ALEBACHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2017
Last Update Date: 07/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 MINNEHAHA AVE
MINNEAPOLIS MN
55417-1647
US

IV. Provider business mailing address

17260 GLENCOE AVE
LAKEVILLE MN
55044-7423
US

V. Phone/Fax

Practice location:
  • Phone: 651-497-8683
  • Fax:
Mailing address:
  • Phone: 651-497-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR198098-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: