Provider Demographics
NPI:1578756805
Name:CLAWSON, BETSY ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:ANN
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167
Mailing Address - Street 2:19 W MAIN STREET
Mailing Address - City:ATLANTA
Mailing Address - State:NY
Mailing Address - Zip Code:14808-0167
Mailing Address - Country:US
Mailing Address - Phone:585-534-5463
Mailing Address - Fax:
Practice Address - Street 1:201 THIRD AVE
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572
Practice Address - Country:US
Practice Address - Phone:585-728-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02857050Medicaid