Provider Demographics
NPI:1235380387
Name:HIGGINBOTHAM, BETH NOEL (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:NOEL
Last Name:HIGGINBOTHAM
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 1:2222 N KILPATRICK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6820
Mailing Address - Country:US
Mailing Address - Phone:417-576-0452
Mailing Address - Fax:
Practice Address - Street 1:2222 N KILPATRICK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6820
Practice Address - Country:US
Practice Address - Phone:417-576-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200630071LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse