Provider Demographics
NPI:1043718927
Name:MEBRATU, BERHANE (NP)
Entity type:Individual
Prefix:
First Name:BERHANE
Middle Name:
Last Name:MEBRATU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9495 SW LOCUST ST STE G
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6683
Mailing Address - Country:US
Mailing Address - Phone:971-314-4899
Mailing Address - Fax:971-314-4798
Practice Address - Street 1:9495 SW LOCUST ST STE G
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6683
Practice Address - Country:US
Practice Address - Phone:559-321-2800
Practice Address - Fax:559-321-2780
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95006949208800000X, 363L00000X
OR10022270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208800000XAllopathic & Osteopathic PhysiciansUrology