Provider Demographics
NPI:1114194602
Name:OUANESISOUK, BOUNTHIENG S (RN)
Entity Type:Individual
Prefix:MRS
First Name:BOUNTHIENG
Middle Name:S
Last Name:OUANESISOUK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19313 GENTRY HIGHLANDS LN
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7577
Mailing Address - Country:US
Mailing Address - Phone:503-442-9573
Mailing Address - Fax:
Practice Address - Street 1:19313 GENTRY HIGHLANDS LN
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7577
Practice Address - Country:US
Practice Address - Phone:503-442-9573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200541699RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical