Provider Demographics
NPI:1558486209
Name:CASEBOLT, CHALLIS ANNETTE (WHC NP)
Entity Type:Individual
Prefix:MS
First Name:CHALLIS
Middle Name:ANNETTE
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:WHC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:530-510-3976
Mailing Address - Fax:
Practice Address - Street 1:1975 MCPHERSON
Practice Address - Street 2:#1
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-2020
Practice Address - Fax:541-756-5828
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200050116NPWHCNPPP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
C94572Medicare UPIN