Healthcare Provider Details

I. General information

NPI: 1043129430
Provider Name (Legal Business Name): HAWI TUFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 NE 19TH ST
GRESHAM OR
97030-4116
US

IV. Provider business mailing address

120 SE 188TH AVE APT 14
PORTLAND OR
97233-5301
US

V. Phone/Fax

Practice location:
  • Phone: 971-336-7430
  • Fax:
Mailing address:
  • Phone: 971-336-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: