Provider Demographics
NPI:1538175757
Name:BETHEL, TAMARA FAYE (FNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:FAYE
Last Name:BETHEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 N COLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7361
Mailing Address - Country:US
Mailing Address - Phone:208-375-8806
Mailing Address - Fax:208-375-8826
Practice Address - Street 1:2308 N COLE RD STE H
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7361
Practice Address - Country:US
Practice Address - Phone:208-375-8806
Practice Address - Fax:208-375-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP524A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily