Healthcare Provider Details

I. General information

NPI: 1659180974
Provider Name (Legal Business Name): BETH PRIEBE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH BARTHOLOMAY RN

II. Dates (important events)

Enumeration Date: 01/01/2025
Last Update Date: 01/01/2025
Certification Date: 01/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 N ELMS RD
FLUSHING MI
48433-9423
US

IV. Provider business mailing address

15274 OLDHAM ST
TAYLOR MI
48180-5057
US

V. Phone/Fax

Practice location:
  • Phone: 810-487-5571
  • Fax:
Mailing address:
  • Phone: 313-316-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704364120
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: