=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073891495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANY A. CROKE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2011
-----------------------------------------------------
Last Update Date | 08/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 FRANCIS ST
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-732-5500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 HUNTINGTON AVE
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02115-6303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-307-2200
-----------------------------------------------------
Fax | 617-568-4780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN2267467
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------