MEDICARE: MARILYNN JANE BOHNSTEDT-CASEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	201804725RN	OR
2	363LF0000X	Family Nurse Practitioner	10010749	OR

General Provider Information

NPI Number	:	1124598057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYNN JANE BOHNSTEDT-CASEY

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-0339
Country	:	US
Telephone Number	:	971-506-6940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1009 MOLALLA AVE STE A
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-3787
Country	:	US
Telephone Number	:	971-506-6940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	07/06/2023

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