Provider Demographics
NPI:1255178117
Name:BECHTOLD, BETH MARIE (CNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:BECHTOLD
Suffix:
Gender:F
Credentials:CNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37535 COUNTY ROAD 155
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:MN
Mailing Address - Zip Code:56310-8737
Mailing Address - Country:US
Mailing Address - Phone:320-333-3473
Mailing Address - Fax:
Practice Address - Street 1:7115 FORTHUN RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8597
Practice Address - Country:US
Practice Address - Phone:218-454-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health