Provider Demographics
NPI:1922795970
Name:BETHEL DANIEL, ALLANA
Entity Type:Individual
Prefix:
First Name:ALLANA
Middle Name:
Last Name:BETHEL DANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11421 204TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2816
Mailing Address - Country:US
Mailing Address - Phone:917-497-3968
Mailing Address - Fax:
Practice Address - Street 1:199 2ND ST APT E509
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-6002
Practice Address - Country:US
Practice Address - Phone:718-866-4569
Practice Address - Fax:718-223-4437
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY588502163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical