Provider Demographics
NPI:1275764623
Name:PENDEXTER, BETSY (RN, APN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:
Last Name:PENDEXTER
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 HAMBURG TPKE STE 205
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5243
Mailing Address - Country:US
Mailing Address - Phone:973-248-1440
Mailing Address - Fax:
Practice Address - Street 1:1777 HAMBURG TPKE STE 205
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5243
Practice Address - Country:US
Practice Address - Phone:973-248-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00230600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health