Provider Demographics
NPI:1770460529
Name:TADESE, SIMEGN GETACHEW
Entity type:Individual
Prefix:
First Name:SIMEGN
Middle Name:GETACHEW
Last Name:TADESE
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 1:16300 NE HOLLADAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5728
Mailing Address - Country:US
Mailing Address - Phone:503-250-4985
Mailing Address - Fax:
Practice Address - Street 1:16300 NE HOLLADAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5728
Practice Address - Country:US
Practice Address - Phone:503-250-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider