Provider Demographics
NPI:1649258591
Name:BETHKE, ELINOR L (RMNS CNS)
Entity type:Individual
Prefix:MS
First Name:ELINOR
Middle Name:L
Last Name:BETHKE
Suffix:
Gender:F
Credentials:RMNS CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2016
Mailing Address - Country:US
Mailing Address - Phone:719-589-5800
Mailing Address - Fax:719-589-5800
Practice Address - Street 1:711 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2016
Practice Address - Country:US
Practice Address - Phone:719-589-5800
Practice Address - Fax:719-589-5800
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37167364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult