Provider Demographics
NPI:1457843427
Name:SCHMITZ, BETTYE JILL (LVN)
Entity Type:Individual
Prefix:
First Name:BETTYE
Middle Name:JILL
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2233
Mailing Address - Country:US
Mailing Address - Phone:210-823-9309
Mailing Address - Fax:
Practice Address - Street 1:2813 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2233
Practice Address - Country:US
Practice Address - Phone:210-823-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175188164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse