Provider Demographics
NPI:1053544767
Name:BINO, MULATU GELETO
Entity type:Individual
Prefix:MR
First Name:MULATU
Middle Name:GELETO
Last Name:BINO
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 1:2520 COUNTY ROAD F E APT 102
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3915
Mailing Address - Country:US
Mailing Address - Phone:414-578-0643
Mailing Address - Fax:
Practice Address - Street 1:2520 COUNTY ROAD F E APT 102
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3915
Practice Address - Country:US
Practice Address - Phone:414-578-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310116-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse