Provider Demographics
NPI:1447789847
Name:BETOUT, LINDSEY (APRN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BETOUT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:217-322-8397
Mailing Address - Fax:
Practice Address - Street 1:7 URBANA ST
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IL
Practice Address - Zip Code:61883-1065
Practice Address - Country:US
Practice Address - Phone:217-260-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000819363LF0000X
MI4704328693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704328693OtherSTATE LICENSE
IL277000819OtherSTATE LICENSE