MEDICARE: MISRAK AYELE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	201141084RN	OR

General Provider Information

NPI Number	:	1003169632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISRAK AYELE

Provider Business Mailing Address
First Line	:	950 SW 21ST AVE APT 1014
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 SW 21ST AVE APT 1014
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1518
Country	:	US
Telephone Number	:	503-449-3925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	10/19/2012

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Directions to “ MISRAK AYELE ” Practice Location

Language	Start Address	Practice Location

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