Provider Demographics
NPI:1932419546
Name:BOTTORFF, ALLEN DEAN (RN)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:DEAN
Last Name:BOTTORFF
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 36
Mailing Address - Street 2:83010 HUNGRY HILL
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426
Mailing Address - Country:US
Mailing Address - Phone:541-915-5819
Mailing Address - Fax:
Practice Address - Street 1:83010 HUNGRY HILL
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426
Practice Address - Country:US
Practice Address - Phone:541-915-5819
Practice Address - Fax:541-895-2636
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201041846RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health