1699804989 NPI number — MRS. CAROLYN J BETLINSKI RN

Table of content: MRS. CAROLYN J BETLINSKI RN (NPI 1699804989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699804989 NPI number — MRS. CAROLYN J BETLINSKI RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETLINSKI
Provider First Name:
CAROLYN
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERWIN
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699804989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9540 MILL CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TILLAMOOK
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97141-8277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-842-3263
Provider Business Mailing Address Fax Number:
503-842-4513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9540 MILL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TILLAMOOK
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97141-8277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-842-3263
Provider Business Practice Location Address Fax Number:
503-842-4513
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , 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: 098307 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com