Healthcare Provider Details

I. General information

NPI: 1912759762
Provider Name (Legal Business Name): REBECCA ANN DONDLINGER PELTON MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE
SALEM OR
97301-2669
US

IV. Provider business mailing address

5237 NE 24TH AVE
PORTLAND OR
97211-6201
US

V. Phone/Fax

Practice location:
  • Phone: 503-945-2800
  • Fax:
Mailing address:
  • Phone: 503-317-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10045174
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: