Provider Demographics
NPI:1386462422
Name:TESFAZION, ASMEROM A
Entity type:Individual
Prefix:
First Name:ASMEROM
Middle Name:A
Last Name:TESFAZION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3517
Mailing Address - Country:US
Mailing Address - Phone:773-317-0753
Mailing Address - Fax:
Practice Address - Street 1:6504 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3517
Practice Address - Country:US
Practice Address - Phone:773-317-0753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide