Derartu Fessa Hayato

Primary specialty

Long-Term Care Clinical Nurse SpecialistTaxonomy code 364SL0600X

License

1109803 Issued in MN

Practice address

3857 Van Dyke St
White Bear Lake, MN 55110-4347

Phone

(952) 688-7128

NPI assigned

Sep 16, 2022

Last updated

May 31, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1912629890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 VAN DYKE ST",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551104347",
            "telephone_number": "952-688-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3857 VAN DYKE ST",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551104347",
            "telephone_number": "952-688-7128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYATO",
        "first_name": "DERARTU",
        "middle_name": "FESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-16",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SL0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Long-Term Care",
            "state": "MN",
            "license": "1109803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashton Carter Hardell
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• Jeanne Marie Hartle
• Samiyo Abdiaziz Hassan
• Gerald D. Hautman, M.D.
• Healthcorps, Inc. (Recover Care)
• Healthsource of White Bear Lake, PLLC
• Maria Isabella Heaney, MA, LPCC
• Iris Heieren, MA, LAMFT
• Helix Chiropractic PA

• Clinical Nurse Specialist in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Clinical Nurse Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.