Individual
BETHANY PACHECO DENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
678 OUTLOOK AVE, WEST BABYLON, NY 11704-4423
(631) 559-4470
Mailing address
678 OUTLOOK AVE, WEST BABYLON, NY 11704-4423
(631) 559-4470
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
804264
NY
164W00000X
Licensed Practical Nurse
317052
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
317052
LPN LICENSE
NY
Enumeration date
05/15/2014
Last updated
01/07/2021
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