Provider Demographics
NPI:1609108687
Name:OGBEIDE, TANELL E (CFNP)
Entity Type:Individual
Prefix:
First Name:TANELL
Middle Name:E
Last Name:OGBEIDE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:TANELL
Other - Middle Name:E
Other - Last Name:TEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 6689
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6689
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:18010 SW MCEWAN RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7868
Practice Address - Country:US
Practice Address - Phone:503-525-7500
Practice Address - Fax:503-525-7515
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850167NP207V00000X, 363L00000X, 363LF0000X
WAAP60098623363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily