Healthcare Provider Details

I. General information

NPI: 1043173818
Provider Name (Legal Business Name): BETH OTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 NE ELAM YOUNG PKWY
HILLSBORO OR
97124-6452
US

IV. Provider business mailing address

5555 NE ELAM YOUNG PKWY
HILLSBORO OR
97124-6452
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number200441144RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: