Provider Demographics
NPI:1003887076
Name:NUELLE, BETHANN MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BETHANN
Middle Name:MARIE
Last Name:NUELLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BETHANN
Other - Middle Name:MARIE
Other - Last Name:LAUF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4700 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-8123
Mailing Address - Country:US
Mailing Address - Phone:701-757-2559
Mailing Address - Fax:
Practice Address - Street 1:4700 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-8123
Practice Address - Country:US
Practice Address - Phone:701-757-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25291363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN309S5NUOtherBCBS MN
P00263990OtherRR MEDICARE
ND19831Medicaid
ND025553OtherBCBS ND
5613280001OtherADMINISTAR
P00263990OtherRR MEDICARE
ND5613280001Medicare NSC
NDQ41571Medicare UPIN
ND25553Medicare PIN