Healthcare Provider Details

I. General information

NPI: 1942018734
Provider Name (Legal Business Name): BETHANY DUSSOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2024
Last Update Date: 12/25/2024
Certification Date: 12/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 HIGHWAY 72 W
MADISON AL
35758-9573
US

IV. Provider business mailing address

8375 HIGHWAY 72 W
MADISON AL
35758-9573
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-2012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1-176144
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: