Provider Demographics
NPI:1245072594
Name:BIGELOW, DEAN (PMHNP)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:BIGELOW
Suffix:
Gender:X
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13260 HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-7526
Mailing Address - Country:US
Mailing Address - Phone:503-341-0003
Mailing Address - Fax:
Practice Address - Street 1:13260 HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-7526
Practice Address - Country:US
Practice Address - Phone:503-341-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10018469363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health