Provider Demographics
NPI:1952826612
Name:ADDIS, BETH ANNE (APN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:ADDIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:LUDLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2106 NEW RD STE F2
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1053
Mailing Address - Country:US
Mailing Address - Phone:609-469-1585
Mailing Address - Fax:
Practice Address - Street 1:2106 NEW RD STE F2
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1053
Practice Address - Country:US
Practice Address - Phone:609-469-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00743700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0455091OtherGROUP MEDICAID
NJ381020OtherGROUP MEDICARE