Individual
BETHANY DIVELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
311 W 24TH ST STE 101, ERIE, PA 16502-2668
(814) 452-4214
Mailing address
4606 WOLF RD, ERIE, PA 16505-1451
(814) 746-6563
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP027834
PA
Other
Enumeration date
07/18/2023
Last updated
09/21/2023
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