Provider Demographics
NPI:1073611851
Name:MCNETT-FETTINGER, BETH D (CPNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:D
Last Name:MCNETT-FETTINGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 N HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:HEMLOCK
Mailing Address - State:MI
Mailing Address - Zip Code:48626-9685
Mailing Address - Country:US
Mailing Address - Phone:989-642-4242
Mailing Address - Fax:
Practice Address - Street 1:5821 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5716
Practice Address - Country:US
Practice Address - Phone:989-797-1051
Practice Address - Fax:989-799-0256
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704126800OtherREGISTERED NURSE LICENSE