Elizabeth L Pethtel, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

O85072196 Issued in OR

Practice address

3170 State St
Medford, OR 97504-8450

Phone

(541) 864-8900

Fax

(541) 245-3315

NPI assigned

Nov 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1043386717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-864-8900",
            "fax_number": "541-245-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3170 STATE ST",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048450",
            "telephone_number": "541-864-8900",
            "fax_number": "541-245-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETHTEL",
        "first_name": "ELIZABETH",
        "middle_name": "L",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "O85072196",
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "OR",
            "license": "085072196N1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112651",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMAP",
            "identifier": "NP (36)",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judy Patricia Peterson
• Mark Delano Peterson, MD
• Suzanne Peterson, LMFT, CADC-IT
• Trevor Peterson, DMD
• Benjamin Petetit
• Kelly A Pettinger, DVM
• Grace Warner Pettygrove
• Laurel Rose Pew
• Lucas Lee Pfeifer, DO
• Heather Pfeil, RN

• Family Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.