Provider Demographics
NPI:1538129432
Name:TAU, BETHANY J
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:TAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR ATTN: CREDENTIAL'S OFFICE
Mailing Address - Street 2:USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:ORTHOPEDIC/PODIARTY CLINIC
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4606
Practice Address - Country:US
Practice Address - Phone:719-526-0721
Practice Address - Fax:719-526-7856
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-170464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse