Provider Demographics
NPI:1972010767
Name:GETTY, WILLIAM SCOTT JR (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:GETTY
Suffix:JR
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 RAECHEL RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97449-9701
Mailing Address - Country:US
Mailing Address - Phone:541-288-3736
Mailing Address - Fax:
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-288-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201800004CRNA-PP367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered