Provider Demographics
NPI:1518348218
Name:RICH, BETHANY (NP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BOSTON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-2321
Mailing Address - Country:US
Mailing Address - Phone:978-670-1300
Mailing Address - Fax:978-528-2024
Practice Address - Street 1:221 BOSTON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2321
Practice Address - Country:US
Practice Address - Phone:978-670-1300
Practice Address - Fax:978-528-2024
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN210735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily