Provider Demographics
NPI:1538938063
Name:EIDE, BETHANY (BSN, RN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:EIDE
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 NE BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2005
Mailing Address - Country:US
Mailing Address - Phone:406-350-0757
Mailing Address - Fax:
Practice Address - Street 1:800 CASINO CREEK DR
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-3356
Practice Address - Country:US
Practice Address - Phone:406-389-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37971163WG0600X, 163WW0000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WW0000XNursing Service ProvidersRegistered NurseWound Care