Provider Demographics
NPI:1336236694
Name:HETHCOTE, DORIS J (NP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:J
Last Name:HETHCOTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 NW LARCH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1323
Mailing Address - Country:US
Mailing Address - Phone:541-526-6635
Mailing Address - Fax:541-526-6636
Practice Address - Street 1:213 NW LARCH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1323
Practice Address - Country:US
Practice Address - Phone:541-526-6635
Practice Address - Fax:541-526-6636
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090006054N7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S28842Medicare UPIN
OR133082Medicare ID - Type Unspecified