Provider Demographics
NPI:1598204455
Name:NIELSEN, BETH (BSHA)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:BSHA
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSHA
Mailing Address - Street 1:340 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 DUNN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2400
Practice Address - Country:US
Practice Address - Phone:845-707-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY563293163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse