Provider Demographics
NPI:1942735683
Name:CHESTER, BETHANY ANN (RN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:CHESTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 E MICHIGAN AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-2006
Mailing Address - Country:US
Mailing Address - Phone:269-967-0576
Mailing Address - Fax:
Practice Address - Street 1:77 MICHIGAN AVE E STE 200
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-7031
Practice Address - Country:US
Practice Address - Phone:269-425-7128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272894163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse