Healthcare Provider Details

I. General information

NPI: 1114682085
Provider Name (Legal Business Name): ANTHONY CHRISTOPHER BASS LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW 37TH ST
PENDLETON OR
97801-3605
US

IV. Provider business mailing address

707 SW 37TH ST
PENDLETON OR
97801-3605
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-3374
  • Fax: 541-276-5326
Mailing address:
  • Phone: 541-276-3374
  • Fax: 541-276-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201602584LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: