Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN190757 | GA |
NPI | 1285094433 |
---|---|
Provider Name | Mr. Mussie Asmerom |
First Address | Atlanta, GA 30329-2305 |
Second Address | Atlanta, GA 30329-2305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2016 |
Last Update Date | 01/03/2016 |