Provider Demographics
NPI:1871114157
Name:HABTESELASSIE, HILLINA (CNP)
Entity type:Individual
Prefix:
First Name:HILLINA
Middle Name:
Last Name:HABTESELASSIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 STELZER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-4007
Mailing Address - Country:US
Mailing Address - Phone:614-473-1300
Mailing Address - Fax:614-473-0722
Practice Address - Street 1:2489 STELZER RD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-4007
Practice Address - Country:US
Practice Address - Phone:614-473-1300
Practice Address - Fax:614-473-0722
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily