Provider Demographics
NPI:1659436152
Name:BROOKS, BETSY JEAN (RN, LMT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:JEAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 NE ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-2271
Mailing Address - Country:US
Mailing Address - Phone:541-272-2047
Mailing Address - Fax:
Practice Address - Street 1:306 SW COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4903
Practice Address - Country:US
Practice Address - Phone:541-272-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27645225700000X
OR200441640RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health