Healthcare Provider Details

I. General information

NPI: 1528627874
Provider Name (Legal Business Name): RHEA ANN BANDELIER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SW BRANTLEY DR
WINSTON OR
97496-4526
US

IV. Provider business mailing address

11 SW BRANTLEY DR
WINSTON OR
97496-4526
US

V. Phone/Fax

Practice location:
  • Phone: 541-679-0366
  • Fax: 541-679-4821
Mailing address:
  • Phone: 541-679-0366
  • Fax: 541-679-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-56443
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10016074
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: