Provider Demographics
NPI:1093431207
Name:HILL, BETHANY LYNN (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 192ND ST S
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-9062
Mailing Address - Country:US
Mailing Address - Phone:612-799-9195
Mailing Address - Fax:
Practice Address - Street 1:1801 45TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-0801
Practice Address - Country:US
Practice Address - Phone:612-799-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR048210163W00000X
MN2405289163W00000X
MNL-136471163WL0100X
NDR31814163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant