Healthcare Provider Details

I. General information

NPI: 1518558774
Provider Name (Legal Business Name): HANA MENGISTU MEKONNEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANA MENGISTU HABTEMARIAM

II. Dates (important events)

Enumeration Date: 01/31/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5033 SW 206TH PL
BEAVERTON OR
97078
US

IV. Provider business mailing address

5033 SW 206TH PL
BEAVERTON OR
97078
US

V. Phone/Fax

Practice location:
  • Phone: 571-447-2134
  • Fax:
Mailing address:
  • Phone: 571-447-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202001158
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: