Provider Demographics
NPI:1689950586
Name:BETHANY ROWLAND PMHNP
Entity Type:Organization
Organization Name:BETHANY ROWLAND PMHNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-224-5808
Mailing Address - Street 1:921 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 812
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2827
Mailing Address - Country:US
Mailing Address - Phone:503-224-5808
Mailing Address - Fax:503-916-8181
Practice Address - Street 1:921 SW WASHINGTON ST
Practice Address - Street 2:SUITE 812
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2827
Practice Address - Country:US
Practice Address - Phone:503-224-5808
Practice Address - Fax:503-916-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080-044756N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649307455OtherTYPE I NPI