Provider Demographics
NPI:1487805271
Name:ERICKSON-CARON, BETHANY A (RNP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:ERICKSON-CARON
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:A
Other - Last Name:ERICKSON-LAKEWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY BLDG 6
Practice Address - Street 2:
Practice Address - City:E PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-435-5533
Practice Address - Fax:401-431-2555
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01130363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBL73622Medicaid
0070607901OtherMEDICARE