Healthcare Provider Details

I. General information

NPI: 1205514007
Provider Name (Legal Business Name): ADDISALEM TESMAMA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 MONTGOMERY RD
CINCINNATI OH
45236-2200
US

IV. Provider business mailing address

4055 VALLEY VIEW LN, DALLAS, TX 75244
DALLAS TX
75244-5071
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-1127
  • Fax:
Mailing address:
  • Phone: 855-984-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0034048
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4006538
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: