Provider Demographics
NPI:1073250924
Name:GIESBRECHT, ETHEL LYNNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:LYNNE
Last Name:GIESBRECHT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8495 CRATER LAKE HWY RM 168
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-3011
Mailing Address - Country:US
Mailing Address - Phone:541-826-2111
Mailing Address - Fax:541-830-7424
Practice Address - Street 1:8495 CRATER LAKE HWY RM 168
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-3011
Practice Address - Country:US
Practice Address - Phone:541-826-2111
Practice Address - Fax:541-830-7424
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201808392LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse