Provider Demographics
NPI:1346555968
Name:HARRIS, BETHANY RAE (LPN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:RAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4707
Mailing Address - Country:US
Mailing Address - Phone:740-297-3299
Mailing Address - Fax:
Practice Address - Street 1:591 DRYDEN RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4707
Practice Address - Country:US
Practice Address - Phone:740-297-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN131852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse