Provider Demographics
NPI:1497183362
Name:PINKERTON, FAITH TAVARES (LD)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:TAVARES
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61383 HWY 97
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2597
Mailing Address - Country:US
Mailing Address - Phone:541-408-4025
Mailing Address - Fax:
Practice Address - Street 1:61383 HWY 97
Practice Address - Street 2:SUITE B
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2597
Practice Address - Country:US
Practice Address - Phone:541-408-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10149667246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other