Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR009561 | GA |
NPI | 1831565084 |
---|---|
Provider Name | Dr. Bethany Miteiko |
First Address | Eureka, CA 95503-5350 |
Second Address | Roswell, GA 30076-8836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 11/01/2021 |