Healthcare Provider Details

I. General information

NPI: 1598444291
Provider Name (Legal Business Name): BETHANY GESKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 ELM ST NE
FARGO ND
58102
US

IV. Provider business mailing address

13448 COUNTY HIGHWAY 31
FRAZEE MN
56544-8888
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax:
Mailing address:
  • Phone: 512-820-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR52315
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: