Provider Demographics
NPI:1528506185
Name:SMITH, BETHANY ANN (MSN, RN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ANN
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1026 A AVE NE
Mailing Address - Street 2:ATTN: 3 CENTER
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5036
Mailing Address - Country:US
Mailing Address - Phone:319-369-7234
Mailing Address - Fax:
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:ATTN: 3 CENTER
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-369-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130970163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse