Basic Information
Provider Information
NPI: 1003145467
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIGHAM
FirstName: BETH
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: APRN, FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/15/2009
LastUpdateDate: 03/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN266651OHN Nursing Service ProvidersRegistered Nurse 
363LF0000X1156SCN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000X13075-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
MB204945801SCFED DEAOTHER


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