Provider Demographics
NPI:1376603449
Name:HALLY, BETSY ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:ANN
Last Name:HALLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MARIOT CIR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5222
Mailing Address - Country:US
Mailing Address - Phone:203-265-3311
Mailing Address - Fax:
Practice Address - Street 1:37 MARIOT CIR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-5222
Practice Address - Country:US
Practice Address - Phone:203-265-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013148164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse