Provider Demographics
NPI:1013934033
Name:BETHEL, DEBORAH A (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BETHEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ROUTE 30 N
Mailing Address - Street 2:CASTLETON FAMILY HEALTH CENTER
Mailing Address - City:BOMOSEEN
Mailing Address - State:VT
Mailing Address - Zip Code:05732-9647
Mailing Address - Country:US
Mailing Address - Phone:802-468-5641
Mailing Address - Fax:802-468-2923
Practice Address - Street 1:275 ROUTE 30 N
Practice Address - Street 2:CASTLETON FAMILY HEALTH CENTER
Practice Address - City:BOMOSEEN
Practice Address - State:VT
Practice Address - Zip Code:05732-9647
Practice Address - Country:US
Practice Address - Phone:802-468-5641
Practice Address - Fax:802-468-2923
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010014964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONS2005Medicaid
VTS25448Medicare UPIN
VTBENS2005Medicare ID - Type Unspecified