Provider Demographics
NPI:1427500735
Name:TESFAGIORGIS, DAWIT KAHSAI (RN)
Entity type:Individual
Prefix:MR
First Name:DAWIT
Middle Name:KAHSAI
Last Name:TESFAGIORGIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 ALDINE STREET APT#8
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-315-2266
Mailing Address - Fax:
Practice Address - Street 1:571 ALDINE ST APT 8
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2206
Practice Address - Country:US
Practice Address - Phone:651-315-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 178892-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse