Provider Demographics
NPI:1174854459
Name:OERTNER, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:OERTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-1108
Mailing Address - Country:US
Mailing Address - Phone:610-739-8654
Mailing Address - Fax:
Practice Address - Street 1:1340 PIN OAK LN
Practice Address - Street 2:
Practice Address - City:SLATINGTON
Practice Address - State:PA
Practice Address - Zip Code:18080-1108
Practice Address - Country:US
Practice Address - Phone:610-739-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004016L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC114016LOtherOT