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NPI Code Detail

MEDICARE: CALEB BETTENHAUSEN

MEDICARE: CALEB BETTENHAUSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1790208973
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALEB BETTENHAUSEN
Provider Business Mailing Address
First Line : 2019 58TH AVE
Second Line :
City : YAKIMA
State : WA
Zip : 98903-1194
Country : US
Telephone Number : 406-218-1105
Fax Number :
Provider Business Practice Location Address
First Line : 2501 BUSINESS LN
Second Line :
City : YAKIMA
State : WA
Zip : 98901-1167
Country : US
Telephone Number : 509-575-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2017
Last Update Date : 07/21/2022

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Directions to “ CALEB BETTENHAUSEN ” Practice Location

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