Provider Demographics
NPI:1770856759
Name:LANDGRAFF, BETHANY PARMER (CRNP, FNP-C, IBCLC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:PARMER
Last Name:LANDGRAFF
Suffix:
Gender:F
Credentials:CRNP, FNP-C, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON BORO
Mailing Address - State:PA
Mailing Address - Zip Code:17582-9717
Mailing Address - Country:US
Mailing Address - Phone:717-471-2019
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN529339L163WL0100X
PASPO26635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASPO26635OtherCRNP (FNP-C) LICENSE