Provider Demographics
NPI:1710708482
Name:RUBINO, BETHANY (FNP-BC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RUBINO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BAY STATE RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1407
Mailing Address - Country:US
Mailing Address - Phone:978-766-4221
Mailing Address - Fax:
Practice Address - Street 1:30 TUSCAN BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3981
Practice Address - Country:US
Practice Address - Phone:978-766-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2324536363LF0000X
NH112733-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily