Basic Information
| Provider Information | |||||||||
| NPI: | 1003145467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIGHAM | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9318 STATE ROUTE 14 | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306263455 | ||||||||
| FaxNumber: | 3306264189 | ||||||||
| Practice Location | |||||||||
| Address1: | 2883 MIDDLETON RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442361907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649056818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2009 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN266651 | OH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 13075-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 1156 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MB2049458 | 01 | SC | FED DEA | OTHER |