Healthcare Provider Details

I. General information

NPI: 1962675652
Provider Name (Legal Business Name): MR. NATHAN ANDREW BETHEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NATHAN ANDREW BETHEL RN

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 COOLIDGE ST
MADISON WI
53704-4510
US

IV. Provider business mailing address

2741 COOLIDGE ST
MADISON WI
53704-4510
US

V. Phone/Fax

Practice location:
  • Phone: 608-246-0550
  • Fax:
Mailing address:
  • Phone: 608-246-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: