Provider Demographics
NPI:1164968467
Name:SANDWICK, BETHANY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SANDWICK
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 1:312 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BADGER
Mailing Address - State:MN
Mailing Address - Zip Code:56714-4004
Mailing Address - Country:US
Mailing Address - Phone:218-528-3258
Mailing Address - Fax:
Practice Address - Street 1:312 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BADGER
Practice Address - State:MN
Practice Address - Zip Code:56714-4004
Practice Address - Country:US
Practice Address - Phone:218-528-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion