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General NPI Number Information
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NPI Number | 1205465770
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Entity Type | Organization
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Legal Business Name | NP BETHANY LLC
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1520 E PIMA ST
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City | PHOENIX
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State | AZ
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Zip | 85034-4639
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Country | US
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Telephone | 602-407-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 9745 E HAMPTON AVE UNIT 1102
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City | MESA
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State | AZ
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Zip | 85209-6301
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Country | US
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Telephone | 815-608-9277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETHANY FETZER
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Credential | DNP, FNP-C, PMHNP-BC
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Telephone | 815-608-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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