Provider Demographics
NPI:1548466055
Name:BROWN, BETHANY JEAN (RN, CNM)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2201 S GETTY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1207
Mailing Address - Country:US
Mailing Address - Phone:231-767-9806
Mailing Address - Fax:231-737-1808
Practice Address - Street 1:1700 OAK AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2407
Practice Address - Country:US
Practice Address - Phone:231-777-2093
Practice Address - Fax:231-773-7500
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704244262163W00000X, 176B00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704244262OtherSTATE LICENSE