Healthcare Provider Details

I. General information

NPI: 1477645687
Provider Name (Legal Business Name): ANN MARIE BETHKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VILLAGE DR STE B
GREENSBURG PA
15601-3783
US

IV. Provider business mailing address

200 VILLAGE DR STE B
GREENSBURG PA
15601-3783
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-0850
  • Fax: 724-832-1623
Mailing address:
  • Phone: 724-832-0850
  • Fax: 724-832-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002191L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: