Provider Demographics
NPI:1649620899
Name:FJELDHEIM, BETHANY JOY (MSN, RN, CNM)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:FJELDHEIM
Suffix:
Gender:F
Credentials:MSN, RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1957
Mailing Address - Country:US
Mailing Address - Phone:585-922-0374
Mailing Address - Fax:
Practice Address - Street 1:2000 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580
Practice Address - Country:US
Practice Address - Phone:585-922-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
NY001758367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife