Individual
ELIZABETH L PETHTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3170 STATE ST, MEDFORD, OR 97504-8450
(541) 864-8900
(541) 245-3315
Mailing address
3170 STATE ST, MEDFORD, OR 97504-8450
(541) 864-8900
(541) 245-3315
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
085072196N1
OR
363LF0000X
Family Nurse Practitioner
Primary
O85072196
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112651
—
OR
01
—
NP (36)
DMAP
OR
Enumeration date
11/27/2006
Last updated
12/28/2011
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