Provider Demographics
NPI:1871342097
Name:ADDEH, TOSIN MERCY (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TOSIN
Middle Name:MERCY
Last Name:ADDEH
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:TOSIN
Other - Middle Name:MERCY
Other - Last Name:ANIFOWOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:6800 SW 105TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5487
Mailing Address - Country:US
Mailing Address - Phone:503-430-1777
Mailing Address - Fax:503-372-5119
Practice Address - Street 1:6800 SW 105TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5487
Practice Address - Country:US
Practice Address - Phone:503-430-1777
Practice Address - Fax:503-372-5119
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161566363LP0808X
OR10030911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health