Provider Demographics
NPI:1639473739
Name:BETHAUSER, ANDREA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BETHAUSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 GLENDALE MILFORD RD, ST. 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3763
Mailing Address - Country:US
Mailing Address - Phone:513-769-2767
Mailing Address - Fax:135-733-0867
Practice Address - Street 1:4260 GLENDALE MILFORD RD, ST. 201
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3763
Practice Address - Country:US
Practice Address - Phone:513-769-2767
Practice Address - Fax:513-733-8677
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002664363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762657Medicare PIN