Provider Demographics
NPI:1083852206
Name:BETTS, BONNIE SUE (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:SUE
Last Name:BETTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5281
Mailing Address - Country:US
Mailing Address - Phone:562-862-5121
Mailing Address - Fax:562-862-8551
Practice Address - Street 1:8635 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5281
Practice Address - Country:US
Practice Address - Phone:562-862-5121
Practice Address - Fax:562-862-8551
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV811300363LW0102X
CA15404363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV811300OtherAPRN-CNP LICENSE
CA442981OtherRN LICENSE