Provider Demographics
NPI:1396126512
Name:EARTHMAN, BETH ANN (CPNP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:EARTHMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3204 ALDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1020
Mailing Address - Country:US
Mailing Address - Phone:512-638-7712
Mailing Address - Fax:
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7263
Practice Address - Country:US
Practice Address - Phone:360-752-5246
Practice Address - Fax:509-865-0757
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60551118363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1396126512Medicaid
WAG8941771OtherMEDICARE