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General NPI Number Information
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NPI Number | 1558034991
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Entity Type | Individual
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Provider Name | TEWOLDEBIRHAN BIRU KERESEMO NP
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Gender | Male
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 791 CHAMBERS RD
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City | AURORA
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State | CO
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Zip | 80011-7112
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Country | US
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Telephone | 303-617-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 4886 S RIVIERA WAY
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City | AURORA
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State | CO
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Zip | 80015-4708
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Country | US
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Telephone | 720-951-6865
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0996238-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0996238-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 0996238-NP
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RXN.0110013-NP
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License Number State | CO
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