Provider Demographics
NPI:1467934265
Name:GIDEON, BETH L
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:L
Last Name:GIDEON
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 1:232 SOUTH 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862
Mailing Address - Country:US
Mailing Address - Phone:308-728-9986
Mailing Address - Fax:308-728-9987
Practice Address - Street 1:232 SOUTH 16TH STREET
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862
Practice Address - Country:US
Practice Address - Phone:308-728-9986
Practice Address - Fax:308-728-9987
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist