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General NPI Number Information
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NPI Number | 1497444863
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Entity Type | Individual
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Provider Name | BETHANY BURTON AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 05/02/2023
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Provider Practice Location Address
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Address Line | 9512 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21234-3100
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Country | US
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Telephone | 410-882-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 S CHARLES ST APT 205
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City | BALTIMORE
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State | MD
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Zip | 21230-4890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R228810
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R228810
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License Number State | MD
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