Individual provider · Type 1 NPI
Bontu Aberra Deressa
Student in an Organized Health Care Education/Training Program · Blaine, MN
NPI number
1720910086
Active
Practice location
3636 110th Ln NE
Blaine, MN 55449-7702
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program Primary | 390200000X | None listed |
| Physician Assistant | 363A00000X | None listed |
Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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About NPI 1720910086
Bontu Aberra Deressa's National Provider Identifier is 1720910086, issued on Jun 1, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Blaine, MN. The record was last updated on Jun 1, 2026.