Provider Demographics
NPI:1497289888
Name:BETTINESKI, JOANNA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:BETTINESKI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N OKLAHOMA PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1055
Mailing Address - Country:US
Mailing Address - Phone:541-969-9843
Mailing Address - Fax:
Practice Address - Street 1:601 N OKLAHOMA PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1055
Practice Address - Country:US
Practice Address - Phone:541-969-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60750704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist