Basic Information
| Provider Information | |||||||||
| NPI: | 1013934033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETHEL | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 ROUTE 30 N | ||||||||
| Address2: | CASTLETON FAMILY HEALTH CENTER | ||||||||
| City: | BOMOSEEN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057329647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024685641 | ||||||||
| FaxNumber: | 8024682923 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 ROUTE 30 N | ||||||||
| Address2: | CASTLETON FAMILY HEALTH CENTER | ||||||||
| City: | BOMOSEEN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057329647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024685641 | ||||||||
| FaxNumber: | 8024682923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1010014964 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | ONS2005 | 05 | VT | MEDICAID |