Basic Information
| Provider Information | |||||||||
| NPI: | 1043294911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POINDEXTER | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | WYLIE | ||||||||
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| Credential: | FAMILY NURSE PRACTIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1247 NE MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413897741 | ||||||||
| FaxNumber: | 5413883832 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 NW OREGON AVE | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977012729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413897741 | ||||||||
| FaxNumber: | 5413883832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 087003360N1 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 240320 | 05 | OR | MEDICAID |