Healthcare Provider Details

I. General information

NPI: 1316880289
Provider Name (Legal Business Name): LEMLEM TIZAZU BERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 14TH AVE N
NASHVILLE TN
37208-3050
US

IV. Provider business mailing address

1553 RED OAK LN
BRENTWOOD TN
37027-1817
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-9400
  • Fax:
Mailing address:
  • Phone: 571-313-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: