Provider Demographics
NPI:1487861191
Name:BETTAH, HENRIETTA TSANYI
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:TSANYI
Last Name:BETTAH
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 1:4795 HUMMINGBIRD CT S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5619
Mailing Address - Country:US
Mailing Address - Phone:614-424-0954
Mailing Address - Fax:
Practice Address - Street 1:4795 HUMMINGBIRD CT S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5619
Practice Address - Country:US
Practice Address - Phone:614-424-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN122216376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator