Provider Demographics
NPI:1346630027
Name:CASTANEDA, MARY BETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 N CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3102
Mailing Address - Country:US
Mailing Address - Phone:330-283-5611
Mailing Address - Fax:
Practice Address - Street 1:1143 N CARPENTER RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-3102
Practice Address - Country:US
Practice Address - Phone:330-283-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.348379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse