MEDICARE: BETHANY PAIGE DEGARSO

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	962802	TX

General Provider Information

NPI Number	:	1275090979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY PAIGE DEGARSO

Provider Business Mailing Address
First Line	:	3108 BONHAM ST
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3108 BONHAM ST
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6346
Country	:	US
Telephone Number	:	903-312-6586
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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Directions to “ BETHANY PAIGE DEGARSO ” Practice Location

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