Provider Demographics
NPI:1790469328
Name:WINTER, BETHANY ROSE (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ROSE
Last Name:WINTER
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GIBSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5792
Mailing Address - Country:US
Mailing Address - Phone:916-774-6802
Mailing Address - Fax:
Practice Address - Street 1:516 GIBSON DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5792
Practice Address - Country:US
Practice Address - Phone:916-774-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator