Provider Demographics
NPI:1962675652
Name:BETHEL, NATHAN ANDREW
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ANDREW
Last Name:BETHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:ANDREW
Other - Last Name:BETHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2741 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4510
Mailing Address - Country:US
Mailing Address - Phone:608-246-0550
Mailing Address - Fax:
Practice Address - Street 1:2741 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4510
Practice Address - Country:US
Practice Address - Phone:608-246-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35026300Medicare PIN