Healthcare Provider Details

I. General information

NPI: 1902057177
Provider Name (Legal Business Name): TIRUAYER NEGATU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 2ND AVE S STE 400
MINNEAPOLIS MN
55402-4010
US

IV. Provider business mailing address

6317 EXECUTIVE BLVD
ROCKVILLE MD
20852-3905
US

V. Phone/Fax

Practice location:
  • Phone: 612-225-1538
  • Fax:
Mailing address:
  • Phone: 240-669-6097
  • Fax: 832-336-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR122619
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR122619
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR122619
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: