Individual
MR. LARRY LEE BARDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MN, PMHNP
Contact information
Practice address
1660 OAK ST SE, SALEM, OR 97301-6942
(503) 316-8817
(503) 316-9037
Mailing address
1708 NW SPRINGHILL DR, ALBANY, OR 97321-1587
(541) 928-0747
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
077038453N6 PMHNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077038453N6 PMHNP-PP
STATE BOARD OF NURSING
OR
Enumeration date
08/07/2006
Last updated
03/07/2023
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