Provider Demographics
NPI:1508196817
Name:PEARSON, BETTINA (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:BETTINA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 PARROTT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4618
Mailing Address - Country:US
Mailing Address - Phone:207-775-6455
Mailing Address - Fax:
Practice Address - Street 1:98 PARROTT ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4618
Practice Address - Country:US
Practice Address - Phone:207-775-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER023002163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant