Provider Demographics
NPI:1922588086
Name:VONDIELINGEN, BETH ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:VONDIELINGEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1124 MEDICAL PL
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2640
Mailing Address - Country:US
Mailing Address - Phone:812-522-1613
Mailing Address - Fax:812-522-6694
Practice Address - Street 1:1124 MEDICAL PL
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2640
Practice Address - Country:US
Practice Address - Phone:812-522-1600
Practice Address - Fax:812-522-6694
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008395A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily