Provider Demographics
NPI:1992413264
Name:MEKONNEN, TSION M
Entity type:Individual
Prefix:MRS
First Name:TSION
Middle Name:M
Last Name:MEKONNEN
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 1:7430 MAYFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685-2497
Mailing Address - Country:US
Mailing Address - Phone:850-758-6321
Mailing Address - Fax:
Practice Address - Street 1:CALVERT HEALTH MEDICAL CENTER
Practice Address - Street 2:100 HOSPITAL RD
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204985163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse