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BONTU ABERRA DERESSA
NPI 1720910086
Student in an Organized Health Care Education/Training Program in Blaine, MN

Active since June 01, 2026
3636 110TH LN NE, BLAINE, MN 55449(763) 318-8981 Get Directions Write a Review

NPPES record last updated: June 1, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Bontu Aberra Deressa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BONTU ABERRA DERESSA (NPI 1720910086) is an individual student in an organized health care education/training program in Blaine, Minnesota and active in the NPI registry since June 2026.

NPPES Registry Identity

NPI1720910086
Entity TypeIndividual
Primary Taxonomy390200000X
Provider Legal NameBONTU ABERRA DERESSA
Location Address3636 110TH LN NEBlaine, MN 55449-7702
Mailing Address3636 110th Ln NeBlaine, MN 55449-7702 · (763) 318-8981
Phone(763) 318-8981
Sole ProprietorNo
Enumeration DateJune 1, 2026
NPPES CertifiedJune 1, 2026
✔ NPI 1720910086 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedPhysician AssistantTaxonomy 363A00000X
3636 110TH LN NE, Blaine, MN 55449
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bontu Deressa's NPI number?

The NPI number for Bontu Deressa is 1720910086. It was assigned to this individual provider in the NPPES registry on June 1, 2026.

Where is Bontu Deressa located?

Bontu Deressa practices at 3636 110th Ln NE, Blaine, MN 55449. The listed phone number is (763) 318-8981.

What is Bontu Deressa's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Bontu Deressa was last updated on June 1, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.