Healthcare Provider Details

I. General information

NPI: 1558231142
Provider Name (Legal Business Name): FEVEN MAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10936 SE WOOD AVE
MILWAUKIE OR
97222-4552
US

IV. Provider business mailing address

10936 SE WOOD AVE
MILWAUKIE OR
97222-4552
US

V. Phone/Fax

Practice location:
  • Phone: 503-344-4735
  • Fax: 503-344-4936
Mailing address:
  • Phone: 503-344-4735
  • Fax: 503-344-4936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberAFH100270
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: