Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201907625NP-PP | OR |
NPI | 1023678224 |
---|---|
Provider Name | Bethany Joy Bivin |
First Address | West Linn, OR 97068-4657 |
Second Address | West Linn, OR 97068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2019 |
Last Update Date | 28/08/2019 |