Provider Demographics
NPI:1497198980
Name:WHIPPLE, BETH A (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:VAN GORDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:301 BESAW RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-2149
Mailing Address - Country:US
Mailing Address - Phone:315-593-7551
Mailing Address - Fax:315-695-1694
Practice Address - Street 1:552 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-2018
Practice Address - Country:US
Practice Address - Phone:315-695-1634
Practice Address - Fax:315-695-1694
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352110-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool