Provider Demographics
NPI:1477645687
Name:BETHKE, ANN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BETHKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VILLAGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3783
Mailing Address - Country:US
Mailing Address - Phone:724-832-0850
Mailing Address - Fax:724-832-1623
Practice Address - Street 1:200 VILLAGE DR STE B
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3783
Practice Address - Country:US
Practice Address - Phone:724-832-0850
Practice Address - Fax:724-832-1623
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002191L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical