Provider Demographics
NPI:1104213479
Name:PATRICK, BETHANY LAUREN (NP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LAUREN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-6614
Mailing Address - Country:US
Mailing Address - Phone:602-263-2220
Mailing Address - Fax:602-916-0600
Practice Address - Street 1:801 E KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6614
Practice Address - Country:US
Practice Address - Phone:602-263-2220
Practice Address - Fax:602-916-0600
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5273363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health