MEDICARE: NICOLE BETHEL

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	RN. 336958	OH

General Provider Information

NPI Number	:	1346580347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BETHEL

Provider Business Mailing Address
First Line	:	1132 GARFIELD AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2236
Country	:	US
Telephone Number	:	937-301-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 GARFIELD AVE
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2236
Country	:	US
Telephone Number	:	937-301-0808
Fax Number	:

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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