Provider Demographics
NPI:1316606494
Name:ROBERTS, BETHANY ANNE (RN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ANNE
Other - Last Name:REAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8710 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97351-9779
Mailing Address - Country:US
Mailing Address - Phone:503-420-9196
Mailing Address - Fax:
Practice Address - Street 1:8710 PARKER RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-9779
Practice Address - Country:US
Practice Address - Phone:503-420-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201800559163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201800559OtherOREGON BOARD OF NURSING
CA95165373OtherCALIFORNIA BOARD OF NURSING