Provider Demographics
NPI:1174002737
Name:PONTIUS, BETHANY CLAIRE (NP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:CLAIRE
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:C
Other - Last Name:WALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4035 GENEVIEVE BLVD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3533
Mailing Address - Country:US
Mailing Address - Phone:330-388-3036
Mailing Address - Fax:
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7246
Practice Address - Fax:330-971-7256
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023381363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health