Provider Demographics
NPI:1427338839
Name:FEHSENFELD, BETHANY LEIGH (RN, MSN, CNM)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEIGH
Last Name:FEHSENFELD
Suffix:
Gender:F
Credentials:RN, MSN, CNM
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Mailing Address - Street 1:21335 COUNTY ROAD 653
Mailing Address - Street 2:
Mailing Address - City:GOBLES
Mailing Address - State:MI
Mailing Address - Zip Code:49055-9242
Mailing Address - Country:US
Mailing Address - Phone:317-694-5446
Mailing Address - Fax:269-729-6640
Practice Address - Street 1:1474 MNO BMADZEWEN WAY
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MI
Practice Address - Zip Code:49052
Practice Address - Country:US
Practice Address - Phone:269-729-4422
Practice Address - Fax:269-729-4460
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704138929367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife