ELIZABETH L PETHTEL FNP NPI 1043386717

NPI Information

NPI: 1043386717
Provider Name: ELIZABETH L PETHTEL, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
3170 STATE ST
MEDFORD, OR
ZIP 97504
Phone: (541) 864-8900
Get Directions

Elizabeth L Pethtel, FNP is a family nurse practitioner in Medford, OR. Elizabeth L Pethtel, FNP NPI is 1043386717. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3170 STATE ST
MEDFORD, OR
ZIP 97504-450
Phone: (541) 864-8900
Fax: (541) 245-3315

The NPI 1043386717 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 11/27/2006 and was last updated on 12/28/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LC1500X	Nurse Practitioner	Community Health	085072196N1	OREGON	No
2	363LF0000X	Nurse Practitioner	Family	O85072196	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	112651	MEDICAID	OREGON
2	C42479	MEDICARE UPIN
3	NP (36)	OTHER	OREGON	DMAP
4	112651	MEDICARE ID-TYPE UNSPECIFIED	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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