NPI 1013498872

Nebiyu Jamal Fanta

Practitioner Driver Saint Paul, MN

Practice location

Address: 478 University Ave W, Saint Paul, MN 55103-1935
Phone: (202) 779-8511

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence M153136798609 (MN)

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Registry record

NPI: 1013498872
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Aug 2018
Record last updated: 28 Aug 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.