Provider Demographics
NPI:1023678224
Name:BIVIN, BETHANY JOY (MSN, APRN, BSN, RN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:BIVIN
Suffix:
Gender:F
Credentials:MSN, APRN, BSN, RN
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:JOY
Other - Last Name:HABERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 8TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 8TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068
Practice Address - Country:US
Practice Address - Phone:971-703-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN708461163W00000X
OR201907625NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse