Healthcare Provider Details

I. General information

NPI: 1336366343
Provider Name (Legal Business Name): TSION ELAINE HAILESELASSIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 TEASLEY LN
DENTON TX
76205-7946
US

IV. Provider business mailing address

1306 TEASLEY LN
DENTON TX
76205-7946
US

V. Phone/Fax

Practice location:
  • Phone: 940-382-5005
  • Fax:
Mailing address:
  • Phone: 940-382-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: