Provider Demographics
NPI:1902057177
Name:NEGATU, TIRUAYER
Entity type:Individual
Prefix:
First Name:TIRUAYER
Middle Name:
Last Name:NEGATU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 2ND AVE S STE 400
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-4010
Mailing Address - Country:US
Mailing Address - Phone:612-225-1538
Mailing Address - Fax:
Practice Address - Street 1:920 2ND AVE S STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-4010
Practice Address - Country:US
Practice Address - Phone:612-225-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122619363LF0000X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily