Provider Demographics
NPI:1790208973
Name:BETTENHAUSEN, CALEB
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:BETTENHAUSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1194
Mailing Address - Country:US
Mailing Address - Phone:406-218-1105
Mailing Address - Fax:
Practice Address - Street 1:2501 BUSINESS LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1167
Practice Address - Country:US
Practice Address - Phone:509-575-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant