Provider Demographics
NPI:1508433608
Name:JAEGER, BETH SUE (FNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:SUE
Last Name:JAEGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 VAUX HALL AVE
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6249
Mailing Address - Country:US
Mailing Address - Phone:608-556-8030
Mailing Address - Fax:
Practice Address - Street 1:381 VAUX HALL AVE
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6249
Practice Address - Country:US
Practice Address - Phone:608-556-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine