Provider Demographics
NPI:1609673318
Name:WAKEHOUSE, BETHLYNN (SOLE PROPRIETOR)
Entity type:Individual
Prefix:
First Name:BETHLYNN
Middle Name:
Last Name:WAKEHOUSE
Suffix:
Gender:
Credentials:SOLE PROPRIETOR
Other - Prefix:
Other - First Name:BETHLYNN
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOLE PROPRIETOR
Mailing Address - Street 1:2106 TITAN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-3420
Mailing Address - Country:US
Mailing Address - Phone:402-250-7296
Mailing Address - Fax:
Practice Address - Street 1:2106 TITAN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-3420
Practice Address - Country:US
Practice Address - Phone:402-250-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker