Provider Demographics
NPI:1144022435
Name:HUNDE, SAMSON LEGESSE
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:LEGESSE
Last Name:HUNDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 LOWRY AVE N STE B
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1161
Mailing Address - Country:US
Mailing Address - Phone:612-259-8026
Mailing Address - Fax:612-259-8026
Practice Address - Street 1:2143 LOWRY AVE N STE B
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1161
Practice Address - Country:US
Practice Address - Phone:612-259-8026
Practice Address - Fax:612-259-8026
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2197995163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health