Provider Demographics
NPI:1841901915
Name:PANCAKE, KATELYN (EMT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:PANCAKE
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9646
Mailing Address - Country:US
Mailing Address - Phone:541-337-3336
Mailing Address - Fax:
Practice Address - Street 1:970 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4612
Practice Address - Country:US
Practice Address - Phone:541-342-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2279E0002X
OR203402207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency Care