Provider Demographics
NPI:1780942698
Name:BELISLE, BETHEL LYN
Entity type:Individual
Prefix:
First Name:BETHEL
Middle Name:LYN
Last Name:BELISLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 SWEET LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-3045
Mailing Address - Country:US
Mailing Address - Phone:541-942-3481
Mailing Address - Fax:
Practice Address - Street 1:4050 LAKE OTIS PKWY STE 111
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5224
Practice Address - Country:US
Practice Address - Phone:907-444-3027
Practice Address - Fax:844-621-5905
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife