=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316891856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHANY HENISER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2026
-----------------------------------------------------
Last Update Date | 02/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 358 BANGOR RD STE 1
-----------------------------------------------------
City | ELLSWORTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04605-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-412-0291
-----------------------------------------------------
Fax | 207-412-0362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 BEECH HILL CROSS RD
-----------------------------------------------------
City | MOUNT DESERT
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04660-6231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-949-4517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | CNP261122
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------