Provider Demographics
NPI:1699463943
Name:BEYENE, FEKADU
Entity type:Individual
Prefix:
First Name:FEKADU
Middle Name:
Last Name:BEYENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SW 143RD AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6151
Mailing Address - Country:US
Mailing Address - Phone:202-352-1021
Mailing Address - Fax:503-372-6369
Practice Address - Street 1:210 SW 143RD AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6151
Practice Address - Country:US
Practice Address - Phone:202-352-1021
Practice Address - Fax:503-372-6369
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD201807452RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse