Healthcare Provider Details

I. General information

NPI: 1043210602
Provider Name (Legal Business Name): BETHANN M CHADWICK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST STE 7
HINGHAM MA
02043-4021
US

IV. Provider business mailing address

175 DERBY ST STE 7
HINGHAM MA
02043-4021
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-2278
  • Fax: 781-740-0233
Mailing address:
  • Phone: 781-749-2278
  • Fax: 781-740-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP007400
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2320299
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: