Provider Demographics
NPI:1144076613
Name:BERHANE, HIRUT (RN)
Entity type:Individual
Prefix:MRS
First Name:HIRUT
Middle Name:
Last Name:BERHANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 102ND TRL N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2064
Mailing Address - Country:US
Mailing Address - Phone:612-386-5560
Mailing Address - Fax:
Practice Address - Street 1:4730 102ND TRL N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2064
Practice Address - Country:US
Practice Address - Phone:161-238-6556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN412517163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health