Provider Demographics
NPI:1336953934
Name:LAROSE, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:LAROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12165 COUNTRY RUN DR
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-8535
Mailing Address - Country:US
Mailing Address - Phone:989-928-7093
Mailing Address - Fax:
Practice Address - Street 1:12165 COUNTRY RUN DR
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8535
Practice Address - Country:US
Practice Address - Phone:989-928-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker