Healthcare Provider Details

I. General information

NPI: 1902417983
Provider Name (Legal Business Name): EPHREM TADESSE BEJIGA CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N LEWIS AVE
SIOUX FALLS SD
57104-7111
US

IV. Provider business mailing address

4419 S DUNLAP AVE
SIOUX FALLS SD
57106-7612
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-4236
  • Fax: 605-322-2097
Mailing address:
  • Phone: 605-521-6381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001810
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: