Provider Demographics
NPI:1912544107
Name:GANZ, BETHANY ANDERSON (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANDERSON
Last Name:GANZ
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4144 2ND PL NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7594
Mailing Address - Country:US
Mailing Address - Phone:651-983-5564
Mailing Address - Fax:
Practice Address - Street 1:115 16TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0347
Practice Address - Country:US
Practice Address - Phone:507-292-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7087OtherMN APRN LICENSE