Provider Demographics
NPI:1215415872
Name:BETZNER, NICOLE DAWN
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DAWN
Last Name:BETZNER
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 1:14205 DARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2129
Mailing Address - Country:US
Mailing Address - Phone:216-346-1347
Mailing Address - Fax:
Practice Address - Street 1:14205 DARLEY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2129
Practice Address - Country:US
Practice Address - Phone:216-346-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist