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General NPI Number Information
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NPI Number | 1952839615
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Entity Type | Individual
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Provider Name | MESELE HADDIS WOLDETSADIK
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Gender | Male
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 428 SHELL CT W
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City | COLUMBUS
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State | OH
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Zip | 43213-4044
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Country | US
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Telephone | 614-852-0402
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Fax |
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Provider Business Mailing Address
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Address Line | 428 SHELL CT W
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City | COLUMBUS
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State | OH
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Zip | 43213-4044
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Country | US
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Telephone | 614-852-0402
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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