Provider Demographics
NPI:1578127585
Name:ROEHM, BETHANY PATRICIA (LPN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:PATRICIA
Last Name:ROEHM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:PATRICIA
Other - Last Name:HINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:342 OHANA NUI CIR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-4518
Mailing Address - Country:US
Mailing Address - Phone:702-574-2516
Mailing Address - Fax:
Practice Address - Street 1:94-450 MOKUOLA ST STE 100
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3388
Practice Address - Country:US
Practice Address - Phone:808-944-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN-19291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse