Provider Demographics
NPI:1811975238
Name:CHENEY, BETH E (APRN)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:E
Last Name:CHENEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-696-0090
Mailing Address - Fax:860-696-0095
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 125
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-696-0090
Practice Address - Fax:860-696-0095
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500001376Medicare ID - Type Unspecified
Q32855Medicare UPIN