Provider Demographics
NPI:1720883697
Name:IYASSU, LINA MELESE (PMHNP)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:MELESE
Last Name:IYASSU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 SE HILLYARD RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7236
Mailing Address - Country:US
Mailing Address - Phone:405-401-1149
Mailing Address - Fax:503-912-1608
Practice Address - Street 1:4180 SE HILLYARD RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7236
Practice Address - Country:US
Practice Address - Phone:405-401-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201805649RN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health