MEDICARE: SUSAN BETHEA CNA

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	3747A0650X	Attendant Care Provider		MI

General Provider Information

NPI Number	:	1417524992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BETHEA CNA

Provider Business Mailing Address
First Line	:	300 BRITTANY DR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48906-1613
Country	:	US
Telephone Number	:	517-862-8227
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BRITTANY DR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48906-1613
Country	:	US
Telephone Number	:	517-862-8227
Fax Number	:

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	06/04/2021

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Directions to “ SUSAN BETHEA CNA” Practice Location

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