Provider Demographics
NPI:1477092716
Name:WALERYSIAK, BETHANY (CRNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:WALERYSIAK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ROARING RUN RD
Mailing Address - Street 2:
Mailing Address - City:BOSWELL
Mailing Address - State:PA
Mailing Address - Zip Code:15531-1832
Mailing Address - Country:US
Mailing Address - Phone:814-341-4400
Mailing Address - Fax:
Practice Address - Street 1:241 SCHOOLHOUSE RD STE 201
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3239
Practice Address - Country:US
Practice Address - Phone:814-266-5650
Practice Address - Fax:814-266-5653
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017221363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care