Provider Demographics
NPI:1245591890
Name:BETTS, WANALEE CHUASIRIPORN (FNP)
Entity Type:Individual
Prefix:
First Name:WANALEE
Middle Name:CHUASIRIPORN
Last Name:BETTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 BROOK RD.
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227
Mailing Address - Country:US
Mailing Address - Phone:804-767-8400
Mailing Address - Fax:804-262-5113
Practice Address - Street 1:5620 BROOK RD.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227
Practice Address - Country:US
Practice Address - Phone:804-767-8400
Practice Address - Fax:804-262-5113
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily