Healthcare Provider Details

I. General information

NPI: 1023678224
Provider Name (Legal Business Name): BETHANY JOY BIVIN MSN, APRN, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY JOY HABERER

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 SW NIMBUS AVE STE 300
BEAVERTON OR
97008-7162
US

IV. Provider business mailing address

8905 SW NIMBUS AVE STE 300
BEAVERTON OR
97008-7162
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-0468
  • Fax: 971-703-1019
Mailing address:
  • Phone: 503-352-0468
  • Fax: 971-703-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN708461
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201907625NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: