Provider Demographics
NPI:1417064015
Name:MUNN, BETHANY JANE (RPSGT)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JANE
Last Name:MUNN
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2281
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05407-2281
Mailing Address - Country:US
Mailing Address - Phone:802-659-4481
Mailing Address - Fax:866-745-4463
Practice Address - Street 1:3472 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-659-4481
Practice Address - Fax:866-745-4463
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other