Healthcare Provider Details

I. General information

NPI: 1124520713
Provider Name (Legal Business Name): BETHANY LAUREN NYSTRAND-IBANEZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ROUTE 22 STE 16
BRIDGEWATER NJ
08807-2943
US

IV. Provider business mailing address

1200 ROUTE 22 STE 16
BRIDGEWATER NJ
08807-2943
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-6113
  • Fax: 732-463-5536
Mailing address:
  • Phone: 908-725-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00785800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: