Provider Demographics
NPI:1265834071
Name:DENMON, BETHANY MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:DENMON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BURLINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-3304
Mailing Address - Country:US
Mailing Address - Phone:607-624-5582
Mailing Address - Fax:
Practice Address - Street 1:4 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-3304
Practice Address - Country:US
Practice Address - Phone:607-624-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY603950163W00000X
NY320090363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse