Healthcare Provider Details

I. General information

NPI: 1538938063
Provider Name (Legal Business Name): BETHANY EIDE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CASINO CREEK DR
LEWISTOWN MT
59457-3356
US

IV. Provider business mailing address

512 NE BOULEVARD ST
LEWISTOWN MT
59457-2005
US

V. Phone/Fax

Practice location:
  • Phone: 406-389-2272
  • Fax:
Mailing address:
  • Phone: 406-350-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number37971
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number37971
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number37971
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: