Healthcare Provider Details

I. General information

NPI: 1114553898
Provider Name (Legal Business Name): ZENEBE GEDAMU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BLVD STE 200
BEAVERTON OR
97006-5236
US

IV. Provider business mailing address

4009 GENESEE PL
WOODBRIDGE VA
22192-5367
US

V. Phone/Fax

Practice location:
  • Phone: 503-385-2918
  • Fax: 971-384-1771
Mailing address:
  • Phone: 703-225-9398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1024337
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178703
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202214981NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: