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General NPI Number Information
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NPI Number | 1972479731
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Entity Type | Individual
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Provider Name | TESFALEM ZEWDNEH
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Gender | Male
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Dates
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Enumeration Date | 10/16/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 11909 SE STANLEY AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-2937
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Country | US
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Telephone | 971-533-9390
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Fax | 503-855-3452
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Provider Business Mailing Address
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Address Line | 11881 SE SUMMER PL
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City | CLACKAMAS
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State | OR
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Zip | 97015-5212
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Country | US
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Telephone | 971-533-9390
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Fax | 503-855-3452
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 201708692LPN
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License Number State | OR
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