Provider Demographics
NPI:1194041921
Name:DANIEL, BETHANY JANEL
Entity Type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:JANEL
Last Name:DANIEL
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 1:1406 S. WESTNEDGE AVE.
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MT
Mailing Address - Zip Code:49008-1371
Mailing Address - Country:US
Mailing Address - Phone:269-383-2350
Mailing Address - Fax:269-383-1257
Practice Address - Street 1:1406 S. WESTNEDGE AVE.
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MT
Practice Address - Zip Code:49008-1371
Practice Address - Country:US
Practice Address - Phone:269-383-2350
Practice Address - Fax:269-383-1257
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies