Provider Demographics
NPI:1518407998
Name:BIRCHETT, BETTY LOU (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:LOU
Last Name:BIRCHETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:LOU
Other - Last Name:BEDNARKEWICZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18429 CONSERVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263
Mailing Address - Country:US
Mailing Address - Phone:618-314-2475
Mailing Address - Fax:
Practice Address - Street 1:18429 CONSERVATION DRIVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263
Practice Address - Country:US
Practice Address - Phone:618-314-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043090634164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse