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General NPI Number Information
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NPI Number | 1205514007
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Entity Type | Individual
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Provider Name | ADDISALEM TESMAMA NP
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Gender | Female
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 8230 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45236-2200
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Country | US
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Telephone | 513-891-1127
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Fax |
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Provider Business Mailing Address
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Address Line | 4055 VALLEY VIEW LN, DALLAS, TX 75244
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City | DALLAS
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State | TX
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Zip | 75244-5071
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Country | US
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Telephone | 855-984-5121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0034048
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4006538
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License Number State | KY
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