Basic Information
Provider Information
NPI: 1619516630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELL
FirstName: APRIL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PSS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 17818
Address2:  
City: SALEM
State: OR
PostalCode: 973057818
CountryCode: US
TelephoneNumber: 5033632021
FaxNumber:  
Practice Location
Address1: 3321 HAROLD DR NE
Address2:  
City: SALEM
State: OR
PostalCode: 973051339
CountryCode: US
TelephoneNumber: 5033632021
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/23/2019
LastUpdateDate: 03/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175T00000XTHW000003900ORY    

No ID Information.


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