Provider Demographics
NPI:1356148605
Name:ASEFAW, SELAM HABTE
Entity type:Individual
Prefix:
First Name:SELAM
Middle Name:HABTE
Last Name:ASEFAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16033 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5162
Mailing Address - Country:US
Mailing Address - Phone:503-287-0472
Mailing Address - Fax:
Practice Address - Street 1:16033 NE STANTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5162
Practice Address - Country:US
Practice Address - Phone:503-287-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR113243374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula