Provider Demographics
NPI:1528268034
Name:WENTWORTH, DEAN ROBINS (FNP)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:ROBINS
Last Name:WENTWORTH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1152
Mailing Address - Street 2:235 LORRAINE STREET
Mailing Address - City:GLENEDEN BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97388
Mailing Address - Country:US
Mailing Address - Phone:971-409-3985
Mailing Address - Fax:
Practice Address - Street 1:6645 GLENEDEN BEACH LOOP STE 1152
Practice Address - Street 2:
Practice Address - City:GLENEDEN BEACH
Practice Address - State:OR
Practice Address - Zip Code:97388
Practice Address - Country:US
Practice Address - Phone:971-409-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75068363LA2200X
OR2007501060NP363LF0000X
OR200750106NP363LF0000X
OR200750106363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274493Medicaid
OR274493Medicaid