MEDICARE: MS. BETHANY RODERER 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	363L00000X	Nurse Practitioner	R142576	MD

General Provider Information

NPI Number	:	1730458571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETHANY RODERER CRNP

Provider Business Mailing Address
First Line	:	8813 MAYWOOD AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5024
Country	:	US
Telephone Number	:	240-535-1569
Fax Number	:

Provider Business Practice Location Address
First Line	:	8813 MAYWOOD AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5024
Country	:	US
Telephone Number	:	240-535-1569
Fax Number	:

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

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	03/07/2023

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