Individual
BETHEL LAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
791 NE 153RD ST, MIAMI, FL 33162-5230
(715) 205-0335
Mailing address
791 NE 153RD ST, MIAMI, FL 33162-5230
(715) 205-0335
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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