Provider Demographics
NPI:1730659780
Name:DANIEL, BETHANEY (LVN)
Entity Type:Individual
Prefix:MS
First Name:BETHANEY
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 N 7TH ST STE 432
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3665
Mailing Address - Country:US
Mailing Address - Phone:602-433-1200
Mailing Address - Fax:
Practice Address - Street 1:4745 N 7TH ST STE 432
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3665
Practice Address - Country:US
Practice Address - Phone:602-433-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301680164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse