Provider Demographics
NPI:1538430327
Name:FRY, BETHANY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 WATERLOO RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2639
Mailing Address - Country:US
Mailing Address - Phone:443-451-1614
Mailing Address - Fax:443-451-1619
Practice Address - Street 1:5900 WATERLOO RD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2639
Practice Address - Country:US
Practice Address - Phone:443-451-1614
Practice Address - Fax:443-451-1619
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily