Provider Demographics
NPI:1518512086
Name:GREEN, BETHANY (DNP, MSN-ED, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:DNP, MSN-ED, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 W SHORT TAILED
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6462
Mailing Address - Country:US
Mailing Address - Phone:801-854-8763
Mailing Address - Fax:
Practice Address - Street 1:10920 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3538
Practice Address - Country:US
Practice Address - Phone:801-878-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9099972-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily