Provider Demographics
NPI:1003102054
Name:DEAN, BETH ANNE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 SILAS DEANE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4223
Mailing Address - Country:US
Mailing Address - Phone:877-707-4442
Mailing Address - Fax:
Practice Address - Street 1:1025 SILAS DEANE HWY STE 101
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4223
Practice Address - Country:US
Practice Address - Phone:877-707-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2583363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical