Healthcare Provider Details

I. General information

NPI: 1235687450
Provider Name (Legal Business Name): BETHANIE VRANEKOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 SCHOLL RD
MANSFIELD OH
44907-1571
US

IV. Provider business mailing address

741 SCHOLL RD
MANSFIELD OH
44907-1571
US

V. Phone/Fax

Practice location:
  • Phone: 419-774-6822
  • Fax: 419-774-5935
Mailing address:
  • Phone: 419-774-6822
  • Fax: 419-774-5935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.151291-MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: