Healthcare Provider Details

I. General information

NPI: 1558025684
Provider Name (Legal Business Name): BETHANY LYNN RATLIFF APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 E STATE ROUTE 73 STE 120
WAYNESVILLE OH
45068-8814
US

IV. Provider business mailing address

2912 SPRINGBORO W STE 201
MORAINE OH
45439-1674
US

V. Phone/Fax

Practice location:
  • Phone: 513-897-0085
  • Fax:
Mailing address:
  • Phone: 937-297-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: