MEDICARE: DR. BETHANIE DEMMITT DNP, APRN, FNP-C

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	363LF0000X	Family Nurse Practitioner	242144	AZ

General Provider Information

NPI Number	:	1790300317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETHANIE DEMMITT DNP, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1130 E MISSOURI AVE STE 180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2736
Country	:	US
Telephone Number	:	602-283-4711
Fax Number	:	602-671-4260

Provider Business Practice Location Address
First Line	:	1130 E MISSOURI AVE STE 180
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2736
Country	:	US
Telephone Number	:	602-283-4711
Fax Number	:	602-671-4260

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

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	09/10/2020

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