Healthcare Provider Details

I. General information

NPI: 1730094392
Provider Name (Legal Business Name): RIELEE BETNAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MOUNTAIN VIEW LN STE 200
FOREST GROVE OR
97116-2894
US

IV. Provider business mailing address

6630 CANTERBURY DR
GLADSTONE OR
97027-1007
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-4773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number232010
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: