Provider Demographics
NPI:1851140214
Name:USHA, ADANE FOGE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ADANE
Middle Name:FOGE
Last Name:USHA
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9257 UNITY ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5743
Mailing Address - Country:US
Mailing Address - Phone:651-263-9014
Mailing Address - Fax:
Practice Address - Street 1:9257 UNITY ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5743
Practice Address - Country:US
Practice Address - Phone:651-263-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2228453163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator