Provider Demographics
NPI:1528568383
Name:STAFFORD, BETTY SUE (LVN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:SUE
Last Name:STAFFORD
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 1:488 OLD BLOOMINGTON RD N
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77905-2118
Mailing Address - Country:US
Mailing Address - Phone:361-649-6070
Mailing Address - Fax:
Practice Address - Street 1:488 OLD BLOOMINGTON RD N
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905-2118
Practice Address - Country:US
Practice Address - Phone:361-649-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134701164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse