Provider Demographics
NPI:1881568160
Name:TADDESSE, NADEW TESEMA (NP)
Entity type:Individual
Prefix:
First Name:NADEW
Middle Name:TESEMA
Last Name:TADDESSE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10602 STONE CANYON RD APT 150
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-4428
Mailing Address - Country:US
Mailing Address - Phone:469-237-7944
Mailing Address - Fax:
Practice Address - Street 1:10602 STONE CANYON RD APT 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-4428
Practice Address - Country:US
Practice Address - Phone:469-237-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171342363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty