Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1156 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 13075-NP | OH |
NPI | 1003145467 |
---|---|
Provider Name | Beth Ann Bigham |
First Address | Streetsboro, OH 44241 |
Second Address | Hudson, OH 44236-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2009 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MB2049458 | FED DEA (01) | SC |