Provider Demographics
NPI:1508266651
Name:SIMONETTI, BETHANY L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:L
Last Name:SIMONETTI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 W 70TH ST
Mailing Address - Street 2:APT 11E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4402
Mailing Address - Country:US
Mailing Address - Phone:717-679-7333
Mailing Address - Fax:
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3322
Practice Address - Country:US
Practice Address - Phone:860-545-8373
Practice Address - Fax:860-545-8233
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily