Active NPI
Deffo Mebrat
- Registered Nurse
- Gresham, OR
National Provider Identifier
1932522166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 200740288
- Practice address
- 135 NW Linneman Ave
Gresham, OR 97030-6248 - Phone
- (971) 678-0443
- Fax
- (503) 328-9705
- NPI assigned
- Jan 23, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 200740288 | OR | Primary |
Addresses
Primary practice location
135 NW Linneman Ave
Gresham, OR 97030-6248
Mailing address
135 NW Linneman Ave
Gresham, OR 97030-6248
Phone (971) 678-0443
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200740288 | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390435200000",
"number": "1932522166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 NW LINNEMAN AVE",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970306248",
"telephone_number": "971-678-0443",
"fax_number": "503-328-9705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 NW LINNEMAN AVE",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970306248",
"telephone_number": "971-678-0443",
"fax_number": "503-328-9705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEBRAT",
"first_name": "DEFFO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-23",
"last_updated": "2014-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "200740288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.