MEDICARE: BETHANY DAVIS RN

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	026.0087395	VT

General Provider Information

NPI Number	:	1336570399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY DAVIS RN

Provider Business Mailing Address
First Line	:	71 PLUSS LN
Second Line	:
City	:	NORTH CLARENDON
State	:	VT
Zip	:	05759-9629
Country	:	US
Telephone Number	:	802-324-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 PLUSS LN
Second Line	:
City	:	NORTH CLARENDON
State	:	VT
Zip	:	05759-9629
Country	:	US
Telephone Number	:	802-324-3979
Fax Number	:

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

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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