Healthcare Provider Details

I. General information

NPI: 1508232331
Provider Name (Legal Business Name): LAURA JANE BETHKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2015
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 VOLVO PKWY
CHESAPEAKE VA
23320-2855
US

IV. Provider business mailing address

1631 PINEDALE LN
CHESAPEAKE VA
23322-1288
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4630
  • Fax: 757-668-4635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172729
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: