Provider Demographics
NPI:1417347840
Name:MESKER, BETHANY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MESKER
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 1:10144 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OAK VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:93022-9728
Mailing Address - Country:US
Mailing Address - Phone:805-320-1541
Mailing Address - Fax:
Practice Address - Street 1:10144 CREEK RD
Practice Address - Street 2:
Practice Address - City:OAK VIEW
Practice Address - State:CA
Practice Address - Zip Code:93022-9728
Practice Address - Country:US
Practice Address - Phone:805-320-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236052176B00000X, 367A00000X
390200000X
CA95012936363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program