Provider Demographics
NPI:1790969491
Name:SEAGREN, BETTE GAY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BETTE
Middle Name:GAY
Last Name:SEAGREN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3101
Mailing Address - Country:US
Mailing Address - Phone:503-263-6611
Mailing Address - Fax:503-266-5674
Practice Address - Street 1:143 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3101
Practice Address - Country:US
Practice Address - Phone:503-263-6611
Practice Address - Fax:503-266-5674
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000037573N1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR282467Medicaid
ORS55992Medicare UPIN
OR282467Medicaid