Healthcare Provider Details

I. General information

NPI: 1881505071
Provider Name (Legal Business Name): BILISUMA K LEGESE I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SIDNEY ST
PITTSBURGH PA
15203-2167
US

IV. Provider business mailing address

2403 SIDNEY ST STE 271
PITTSBURGH PA
15203-2163
US

V. Phone/Fax

Practice location:
  • Phone: 651-444-9922
  • Fax:
Mailing address:
  • Phone: 651-444-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14564
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: