Individual
HAWI FANTAYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
2327 SE 157TH AVE, PORTLAND, OR 97233-3707
(813) 407-6718
Mailing address
2327 SE 157TH AVE, PORTLAND, OR 97233-3707
(813) 407-6718
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
202108059RN
OR
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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