Basic Information
| Provider Information | |||||||||
| NPI: | 1053421701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOTH | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 W REYNOLDS ST | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | PONTIAC | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617649774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158422828 | ||||||||
| FaxNumber: | 8158424912 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 W REYNOLDS ST | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | PONTIAC | ||||||||
| State: | IL | ||||||||
| PostalCode: | 617649774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158422828 | ||||||||
| FaxNumber: | 8158424912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 367500000X | PENDING | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.