Provider Demographics
NPI:1144588898
Name:BETTS, TAVNIAH LEIGH (CPM)
Entity Type:Individual
Prefix:
First Name:TAVNIAH
Middle Name:LEIGH
Last Name:BETTS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E KENT RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1421
Mailing Address - Country:US
Mailing Address - Phone:218-340-3693
Mailing Address - Fax:
Practice Address - Street 1:25 E KENT RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1421
Practice Address - Country:US
Practice Address - Phone:218-340-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife