MEDICARE: MRS. BETHANN M CHADWICK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	SP007400	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN2320299	MA

General Provider Information

NPI Number	:	1043210602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANN M CHADWICK CRNP

Provider Business Mailing Address
First Line	:	175 DERBY ST STE 7
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4021
Country	:	US
Telephone Number	:	781-749-2278
Fax Number	:	781-740-0233

Provider Business Practice Location Address
First Line	:	175 DERBY ST STE 7
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4021
Country	:	US
Telephone Number	:	781-749-2278
Fax Number	:	781-740-0233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	04/01/2026

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