Basic Information
Provider Information
NPI: 1487088977
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NELSON
FirstName: BETHANY
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2633 P ST
Address2:  
City: LINCOLN
State: NE
PostalCode: 685033528
CountryCode: US
TelephoneNumber: 4024758717
FaxNumber:  
Practice Location
Address1: 1000 S 13TH ST
Address2:  
City: LINCOLN
State: NE
PostalCode: 685083533
CountryCode: US
TelephoneNumber: 4024755161
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/03/2013
LastUpdateDate: 09/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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