Provider Demographics
NPI:1679626964
Name:BENTSON-ROYAL, ROBERTA CAROLYN (PNP)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:CAROLYN
Last Name:BENTSON-ROYAL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SW STARK ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2347
Mailing Address - Country:US
Mailing Address - Phone:503-988-3674
Mailing Address - Fax:503-988-3676
Practice Address - Street 1:426 SW STARK ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2347
Practice Address - Country:US
Practice Address - Phone:503-988-3674
Practice Address - Fax:503-988-3676
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200050055NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics