MEDICARE: BETH FAHLBERG

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	163W00000X	Registered Nurse	158869-30	WI

General Provider Information

NPI Number	:	1326348889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH FAHLBERG

Provider Business Mailing Address
First Line	:	600 HIGHLAND AVE
Second Line	:	CSC K6/316
City	:	MADISON
State	:	WI
Zip	:	53792-2455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HIGHLAND AVE
Second Line	:	CSC K6/316
City	:	MADISON
State	:	WI
Zip	:	53792-2455
Country	:	US
Telephone Number	:	608-338-8935
Fax Number	:

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	10/29/2010

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Directions to “ BETH FAHLBERG ” Practice Location

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