Provider Demographics
NPI:1780396861
Name:KUBIAS, BETHANY J (CRNP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:KUBIAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2746
Mailing Address - Country:US
Mailing Address - Phone:724-457-6258
Mailing Address - Fax:724-457-6192
Practice Address - Street 1:962 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2746
Practice Address - Country:US
Practice Address - Phone:724-457-6258
Practice Address - Fax:724-457-6192
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily