Provider Demographics
NPI:1225826654
Name:SETEGNE, TADESSE LACHU
Entity type:Individual
Prefix:
First Name:TADESSE
Middle Name:LACHU
Last Name:SETEGNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 SE 174TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-4714
Mailing Address - Country:US
Mailing Address - Phone:310-310-1538
Mailing Address - Fax:
Practice Address - Street 1:1612 SE 174TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-4714
Practice Address - Country:US
Practice Address - Phone:310-310-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRN163W00000X
OR10020111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse