Healthcare Provider Details

I. General information

NPI: 1376407759
Provider Name (Legal Business Name): KALKIDAN D WORKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 ARMSTRONG AVE # 102
SAINT PAUL MN
55102-3800
US

IV. Provider business mailing address

626 ARMSTRONG AVE STE 102
SAINT PAUL MN
55102-3800
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-4261
  • Fax:
Mailing address:
  • Phone: 202-621-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number423050
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: