Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD.MD.60762477 | WA |
NPI | 1003235474 |
---|---|
Provider Name | Dr. Bethany Wohletz |
First Address | Salem, OR 97304-3116 |
Second Address | Salem, OR 97304-3116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 29/07/2017 |