MR. LARRY LEE BARDELL (NPI# 1023027877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023027877 |
| Entity Type | Individual |
| Full Name | MR. LARRY LEE BARDELL |
| Credential | MN, PMHNP |
| Practice Address |
1660 Oak St Se Salem OR 97301-6942 |
| Mailing Address |
1708 Nw Springhill Dr Albany OR 97321-1587 |
| Practice Telephone | 5033168817 |
| Practice Fax Number | 5033169037 |
| Mailing Telephone | 5419280747 |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
077038453N6 PMHN | OR | Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA REGISTRATION | MB0143228 | 01 | |
| OR | STATE BOARD OF NURSING | 077038453N6 PMHNP-PP | 01 |
| Street Address |
1660 OAK ST SE |
| City | SALEM |
| State | OR |
| Zip Code | 97301-6942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629362348 | Janice Margaret Rutschman | Social Worker | 1660 Oak St Se, Suite 100, Salem, OR 97301-6942 | 2011-05-31 |
| 1144556457 | Holly Krzyaniak | Social Worker | 1660 Oak St Se, Suite 100, Salem, OR 97301-6942 | 2009-10-21 |
| 1962589176 | Abdul Hai Kazemy | Internal Medicine | 1660 Oak St Se, Salem, OR 97301-6942 | 2006-11-01 |
| 1265522189 | David Frank Schmidt | Internal Medicine | 1660 Oak St Se, Salem Va Clinic, Salem, OR 97301-6942 | 2006-10-13 |
| 1013016591 | Betty Ang | Nurse Practitioner | 1660 Oak St Se, Salem Va Outpatient Clinic, Salem, OR 97301-6942 | 2006-09-21 |
| 1457457707 | Clifford David Lynam | Psychiatry & Neurology | 1660 Oak St Se, Salem, OR 97301-6942 | 2006-09-15 |
| 1922017037 | Dani Alkadi | Internal Medicine | 1660 Oak St Se, Salem, OR 97301-6942 | 2006-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043846942 | Debra Louise Booth | Registered Nurse | 19 Bryant St, Salem, MA 01970-2330 | 2020-03-23 |
| 1003315045 | Ryan Tateishi | Registered Nurse | 966 12th St Se Ste 110, Salem, OR 97302-2860 | 2018-02-05 |
| 1447449541 | Mertice Marie Spencer | Registered Nurse | 4778 Charmalee Ct Ne, Salem, OR 97305-3028 | 2007-10-15 |
| 1720141039 | Donald Paul Gesner | Registered Nurse | 4559 14th Pl S, Salem, OR 97302-2306 | 2006-12-18 |
| 1932727963 | Jessica Pepin | Registered Nurse | 81 Highland Ave, Salem, MA 01970-2714 | 2020-07-07 |
| 1912521816 | Nicholas Jordan Adair | Registered Nurse | 2045 Silverton Rd Ne Ste B, Salem, OR 97301-0100 | 2020-06-05 |
| 1659870996 | Donna Estelle Hoffman | Registered Nurse | 3325 Harold Dr Ne, Salem, OR 97305-1339 | 2018-02-01 |
| 1639509888 | Michael P Tremko | Registered Nurse | 2250 D St Ne, Salem, OR 97301 | 2013-11-24 |
| 1033489034 | Elisabeth Pauline Staten | Registered Nurse | 41 Mason St, Salem, MA 01970-2260 | 2012-01-06 |
| 1851534838 | Joan De Vour | Registered Nurse | 3180 Center St Ne, Salem, OR 97301-4532 | 2009-04-07 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.