Provider Demographics
NPI:1518558774
Name:MEKONNEN, HANA MENGISTU (RN)
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:MENGISTU
Last Name:MEKONNEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HANA
Other - Middle Name:MENGISTU
Other - Last Name:HABTEMARIAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5033 SW 206TH PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078
Mailing Address - Country:US
Mailing Address - Phone:571-447-2134
Mailing Address - Fax:
Practice Address - Street 1:5033 SW 206TH PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078
Practice Address - Country:US
Practice Address - Phone:571-447-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-31
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202001158163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse