Provider Demographics
NPI:1215705116
Name:NEDI, MEKLIT WORKU
Entity type:Individual
Prefix:
First Name:MEKLIT
Middle Name:WORKU
Last Name:NEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21912 NE SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-8780
Mailing Address - Country:US
Mailing Address - Phone:971-990-9895
Mailing Address - Fax:
Practice Address - Street 1:3631 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-7452
Practice Address - Country:US
Practice Address - Phone:971-990-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142950RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse