Healthcare Provider Details

I. General information

NPI: 1215331566
Provider Name (Legal Business Name): BETHANY JANE ABDE AGNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY JANE PEREIRA AGNP - BC

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROSEBROOK WAY
WAREHAM MA
02571-1138
US

IV. Provider business mailing address

200 MILL RD SUITE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-273-4900
  • Fax: 508-273-4901
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN259875
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: