Provider Demographics
NPI:1255685699
Name:DAVIS, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:DAVIS
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 1:16236 EVANS PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-6449
Mailing Address - Country:US
Mailing Address - Phone:402-502-8103
Mailing Address - Fax:402-505-3923
Practice Address - Street 1:16236 EVANS PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6449
Practice Address - Country:US
Practice Address - Phone:402-502-8103
Practice Address - Fax:402-505-3923
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE763237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist