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General NPI Number Information
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NPI Number | 1457260218
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Entity Type | Individual
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Provider Name | NEGUSSU MENGISTU LEGESSE RN
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Gender | Male
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Dates
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Enumeration Date | 09/05/2026
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Last Update Date | 09/05/2026
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Provider Practice Location Address
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Address Line | 6800 SCENIC DR STE 1071
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City | ROWLETT
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State | TX
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Zip | 75088-4552
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Country | US
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Telephone | 972-520-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 8376 RADIANT ST
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City | GARLAND
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State | TX
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Zip | 75043-4864
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Country | US
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Telephone | 469-278-2518
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 824871
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License Number State | TX
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