Provider Demographics
NPI:1568036705
Name:WHITE, BETHANY LYNN
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNN
Last Name:WHITE
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 1:3013 HIGHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3925
Mailing Address - Country:US
Mailing Address - Phone:989-859-4690
Mailing Address - Fax:
Practice Address - Street 1:3013 HIGHBROOK DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3925
Practice Address - Country:US
Practice Address - Phone:989-859-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703117120164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse