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Contact Information

EBISE BAYISA
12457 MIDWAY CIR NE
BLAINE, MN55449-6228
 Phone: 612-423-5057
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Respite Care, Physical Disabilities, Child

385HR2065X
Indicates primary specialty

NPI Profile & details for EBISE BAYISA · (Female)

NPI # 1538745047
Status Active
Credentials
Entity Individual
Enumeration date 03/23/2021
Last updated 03/23/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • MN Medicaid 612653119
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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