DERARTU FESSA HAYATO
NPI 1912629890
Clinical Nurse Specialist - Long-Term Care in White Bear Lake, MN
Active since September 16, 2022
About Derartu Fessa Hayato NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DERARTU FESSA HAYATO (NPI 1912629890) is an individual long-term care provider in White Bear Lake, Minnesota, licensed in Minnesota (1109803) and active in the NPI registry since September 2022.
NPPES Registry Identity
NPI1912629890
Entity TypeIndividualFemale
Primary Taxonomy364SL0600X
Provider Legal NameDERARTU FESSA HAYATO
Location Address3857 VAN DYKE STWhite Bear Lake, MN 55110-4347
Mailing Address3857 Van Dyke StWhite Bear Lake, MN 55110-4347 · (952) 688-7128
Phone(952) 688-7128
Sole ProprietorNo
Enumeration DateSeptember 16, 2022
Last NPPES UpdateMay 31, 2024
NPPES CertifiedMay 31, 2024
✔ NPI 1912629890 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyClinical Nurse Specialist · Long-Term CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code364SL0600X
License✔ Licensed in MN · 1109803
3857 VAN DYKE ST, White Bear Lake, MN 55110
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1912629890, enumerated as an "individual" on September 16, 2022.
The provider is located at 3857 VAN DYKE ST WHITE BEAR LAKE, MN 55110 and the phone number is (952) 688-7128.
Clinical Nurse Specialist with taxonomy code 364SL0600X and a focus in Long-Term Care.
