Healthcare Provider Details

I. General information

NPI: 1851923205
Provider Name (Legal Business Name): BETH FRETTIM PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8191 BIRCHWOOD CT UNIT A
JOHNSTON IA
50131-2931
US

IV. Provider business mailing address

2500 82ND PL
URBANDALE IA
50322-4329
US

V. Phone/Fax

Practice location:
  • Phone: 515-217-4847
  • Fax: 515-257-1499
Mailing address:
  • Phone: 515-412-5112
  • Fax: 515-412-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG157787
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: