MEDICARE: DR. BETH RETTEW HAMSTRA RN, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	47516	CO

General Provider Information

NPI Number	:	1003057084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH RETTEW HAMSTRA RN, PHD

Provider Business Mailing Address
First Line	:	4775 JAMESTOWN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2725
Country	:	US
Telephone Number	:	719-502-9610
Fax Number	:	719-574-3776

Provider Business Practice Location Address
First Line	:	4775 JAMESTOWN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2725
Country	:	US
Telephone Number	:	719-502-9610
Fax Number	:	719-574-3776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2009
Last Update Date	:	03/20/2009

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