Provider Demographics
NPI:1558544262
Name:HAVEL, BETTY LORRAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:LORRAINE
Last Name:HAVEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 1/2 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5505
Mailing Address - Country:US
Mailing Address - Phone:607-786-0624
Mailing Address - Fax:
Practice Address - Street 1:19 1/2 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5505
Practice Address - Country:US
Practice Address - Phone:607-786-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499484-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse