Provider Demographics
NPI:1992401202
Name:HAYWARD, BETHANY L
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:HAYWARD
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 1:13649 S MERIBEL WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6914
Mailing Address - Country:US
Mailing Address - Phone:623-910-2952
Mailing Address - Fax:
Practice Address - Street 1:13649 S MERIBEL WAY
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6914
Practice Address - Country:US
Practice Address - Phone:623-910-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10614779-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily