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
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

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

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1720910086, enumerated as an "individual" on June 01, 2026.

The provider is located at 3636 110TH LN NE BLAINE, MN 55449 and the phone number is (763) 318-8981.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.