Provider Demographics
NPI:1538924998
Name:WOSENU, TIRSTE
Entity type:Individual
Prefix:
First Name:TIRSTE
Middle Name:
Last Name:WOSENU
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 1:3056 NE 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1621
Mailing Address - Country:US
Mailing Address - Phone:614-684-8672
Mailing Address - Fax:503-386-2242
Practice Address - Street 1:3056 NE 127TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1621
Practice Address - Country:US
Practice Address - Phone:614-684-8672
Practice Address - Fax:503-386-2242
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDZ1494311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home