1689950586 NPI number — BETHANY ROWLAND PMHNP

Table of content: (NPI 1689950586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689950586 NPI number — BETHANY ROWLAND PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHANY ROWLAND PMHNP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689950586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
921 SW WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 812
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205-2827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-224-5808
Provider Business Mailing Address Fax Number:
503-916-8181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 SW WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 812
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-224-5808
Provider Business Practice Location Address Fax Number:
503-916-8181
Provider Enumeration Date:
10/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ROWLAND
Authorized Official First Name:
BETHANY
Authorized Official Middle Name:
SUZANNE
Authorized Official Title or Position:
SOLE PRACTITIONER
Authorized Official Telephone Number:
503-224-5808

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  080-044756N6 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1649307455 . This is a "TYPE I NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com