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NPI Code Detail

MEDICARE: BETH THEIS CRNP

MEDICARE: BETH THEIS CRNP
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
1363L00000XNurse PractitionerSP009512PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1SP009512OTHERPALICENSE

General Provider Information

NPI Number : 1265613566
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETH THEIS CRNP
Provider Business Mailing Address
First Line : 415 3RD ST
Second Line :
City : CALIFORNIA
State : PA
Zip : 15419-1102
Country : US
Telephone Number : 724-938-7466
Fax Number : 724-938-7470
Provider Business Practice Location Address
First Line : 415 3RD ST
Second Line :
City : CALIFORNIA
State : PA
Zip : 15419-1102
Country : US
Telephone Number : 724-938-7466
Fax Number : 724-938-7470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2007
Last Update Date : 01/16/2014

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