Provider Demographics
NPI:1659127108
Name:MORAN, BETHANY DURRENCE (RN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:DURRENCE
Last Name:MORAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13100
Mailing Address - Street 2:
Mailing Address - City:JEKYLL ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31527-0100
Mailing Address - Country:US
Mailing Address - Phone:678-787-7460
Mailing Address - Fax:
Practice Address - Street 1:317 6TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4108
Practice Address - Country:US
Practice Address - Phone:855-584-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse