Healthcare Provider Details

I. General information

NPI: 1639931850
Provider Name (Legal Business Name): BETHANY LENEE FORDYCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EASY ST
UNIONTOWN PA
15401-3128
US

IV. Provider business mailing address

205 EASY ST
UNIONTOWN PA
15401-3128
US

V. Phone/Fax

Practice location:
  • Phone: 724-912-7511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN623514
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: