Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 47275 | KY |
NPI | 1003126996 |
---|---|
Provider Name | Dr. Berhanemeskel Nesketa |
First Address | Owensboro, KY 42304-3229 |
Second Address | Owensboro, KY 42303-9774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2010 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201249550 | (05) | IN |
7100304030 | (05) | KY |