Healthcare Provider Details

I. General information

NPI: 1083532899
Provider Name (Legal Business Name): LULIE AYANSA SENBETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14180 AUTUMNWOOD TRL
ROSEMOUNT MN
55068-2224
US

IV. Provider business mailing address

14180 AUTUMNWOOD TRL
ROSEMOUNT MN
55068-2224
US

V. Phone/Fax

Practice location:
  • Phone: 763-607-8602
  • Fax:
Mailing address:
  • Phone: 763-607-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberFCG082
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: