1871219352 NPI number — BETHANY PHELPS MSN FNP-C

Table of content: BETHANY PHELPS MSN FNP-C (NPI 1871219352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871219352 NPI number — BETHANY PHELPS MSN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS
Provider First Name:
BETHANY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PULICE
Provider Other First Name:
BETHANY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871219352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 LOMB MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-5690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-922-3100
Provider Business Mailing Address Fax Number:
585-922-3109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 LOMB MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-5690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-922-3100
Provider Business Practice Location Address Fax Number:
585-922-3109
Provider Enumeration Date:
10/17/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F350507-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)