Healthcare Provider Details

I. General information

NPI: 1780208686
Provider Name (Legal Business Name): BETHANY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BENNING ST STE 160 #208
WEST LEBANON NH
03784-3402
US

IV. Provider business mailing address

10 BENNING ST STE 160
WEST LEBANON NH
03784-3402
US

V. Phone/Fax

Practice location:
  • Phone: 603-601-4766
  • Fax: 603-506-6362
Mailing address:
  • Phone: 603-601-4766
  • Fax: 603-506-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. VANNESSA DAVIS
Title or Position: NP
Credential: DNP, APRN
Phone: 603-601-4766