Provider Demographics
NPI:1124433693
Name:TESFAY, EDNA ANGHESOM (LPN)
Entity type:Individual
Prefix:MRS
First Name:EDNA
Middle Name:ANGHESOM
Last Name:TESFAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NE GREERIDGE TERRACE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124
Mailing Address - Country:US
Mailing Address - Phone:314-387-8837
Mailing Address - Fax:
Practice Address - Street 1:140 NE GREENRIDGE TER
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5160
Practice Address - Country:US
Practice Address - Phone:314-387-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030531 LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse