Provider Demographics
NPI:1417409764
Name:BEDASO, FAYE
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:BEDASO
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 1:13041 SE ALDER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1628
Mailing Address - Country:US
Mailing Address - Phone:503-703-4539
Mailing Address - Fax:503-200-1068
Practice Address - Street 1:13041 SE ALDER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1628
Practice Address - Country:US
Practice Address - Phone:503-703-4539
Practice Address - Fax:503-200-1068
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200940853RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse