Provider Demographics
NPI:1821851841
Name:HETT, CORTNEY MAIRIE (RN)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:MAIRIE
Last Name:HETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 SE 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4676
Mailing Address - Country:US
Mailing Address - Phone:970-589-9118
Mailing Address - Fax:
Practice Address - Street 1:4011 SE 124TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4676
Practice Address - Country:US
Practice Address - Phone:970-589-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60285938163W00000X
OR201242617RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse