Provider Demographics
NPI:1235990888
Name:BETTY, TABITHA (RN)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:BETTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 N MAIN ST APT 1N
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-1341
Mailing Address - Country:US
Mailing Address - Phone:508-212-4878
Mailing Address - Fax:
Practice Address - Street 1:29 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2904
Practice Address - Country:US
Practice Address - Phone:508-212-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2389392163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse