Provider Demographics
NPI:1649668328
Name:WITTEN, BETHANY ROSE MARIA (CPM)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ROSE MARIA
Last Name:WITTEN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ALSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03602-3907
Mailing Address - Country:US
Mailing Address - Phone:207-274-0341
Mailing Address - Fax:
Practice Address - Street 1:1248 FOREST RD
Practice Address - Street 2:
Practice Address - City:ALSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03602
Practice Address - Country:US
Practice Address - Phone:207-274-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT107.0129903176B00000X
NH1060176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife