MEDICARE: BETHANY LAUREN HAFLE CNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0042428	OH

General Provider Information

NPI Number	:	1861326936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY LAUREN HAFLE CNP

Provider Business Mailing Address
First Line	:	799 TAMARACK CT APT B
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-8738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	799 TAMARACK CT APT B
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-8738
Country	:	US
Telephone Number	:	937-725-2161
Fax Number	:

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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