Basic Information
| Provider Information | |||||||||
| NPI: | 1730270398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOLENTINO | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | HARTENSTEIN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1823 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857762800 | ||||||||
| FaxNumber: | 7855654754 | ||||||||
| Practice Location | |||||||||
| Address1: | 1823 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857762800 | ||||||||
| FaxNumber: | 7855654754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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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 | 363AM0700X | 15-00998 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 068002317 | 01 | KS | MEDICARE PTAN | OTHER |