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Individual
BETHEL LAINE
Active
Individual
BETHEL LAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
9358430
FL
363LP2300X
Primary Care Nurse Practitioner
Primary
9358430
FL
Other
Enumeration date
10/22/2014
Last updated
06/16/2015
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