Provider Demographics
NPI:1831601335
Name:GRANT, BETHANY (ARNP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:641-428-3059
Practice Address - Street 1:702 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IA
Practice Address - Zip Code:50468-1324
Practice Address - Country:US
Practice Address - Phone:641-756-3303
Practice Address - Fax:641-756-2475
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA115840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily