Provider Demographics
NPI:1760993828
Name:GADD, BETHANY JEAN (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JEAN
Last Name:GADD
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7211 CARDINAL ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4107
Mailing Address - Country:US
Mailing Address - Phone:810-335-3698
Mailing Address - Fax:
Practice Address - Street 1:13430 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3187
Practice Address - Country:US
Practice Address - Phone:586-427-1351
Practice Address - Fax:586-468-5669
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704266651163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice