Provider Demographics
NPI:1972310829
Name:BAISSA, JOSEPH TESFAYE
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TESFAYE
Last Name:BAISSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEMECHIS
Other - Middle Name:TESFAYE
Other - Last Name:BAISSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:536 ATHENS DR
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5601
Mailing Address - Country:US
Mailing Address - Phone:425-344-1117
Mailing Address - Fax:509-905-3001
Practice Address - Street 1:536 ATHENS DR
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5601
Practice Address - Country:US
Practice Address - Phone:425-344-1117
Practice Address - Fax:509-905-3001
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide