Healthcare Provider Details

I. General information

NPI: 1336495407
Provider Name (Legal Business Name): BETH ANN MONSEBROTEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HIGHWAY 71 S SUITE 101
HOT SPRINGS SD
57747-8801
US

IV. Provider business mailing address

1100 HIGHWAY 71 S SUITE 101
HOT SPRINGS SD
57747-8801
US

V. Phone/Fax

Practice location:
  • Phone: 605-745-5188
  • Fax: 605-745-3039
Mailing address:
  • Phone: 605-745-5188
  • Fax: 605-745-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000728
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: