Provider Demographics
NPI:1760868434
Name:PRINCE, BETHANY BRICEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:BRICEN
Last Name:PRINCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WEEDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15868-3804
Mailing Address - Country:US
Mailing Address - Phone:781-248-9938
Mailing Address - Fax:
Practice Address - Street 1:108 FRANCISCAN WAY
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-9703
Practice Address - Country:US
Practice Address - Phone:814-472-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014988363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health