Healthcare Provider Details

I. General information

NPI: 1063243210
Provider Name (Legal Business Name): BETHANY LOUISE DEWKETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-0001
US

IV. Provider business mailing address

114 CHALK POND RD
NEWBURY NH
03255-6014
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7256
  • Fax:
Mailing address:
  • Phone: 603-731-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number058103-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number058103-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number058103-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: