Provider Demographics
NPI:1578961991
Name:WILLIAMS, BETTY JO (GRNA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:GRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-9622
Mailing Address - Country:US
Mailing Address - Phone:724-496-0001
Mailing Address - Fax:
Practice Address - Street 1:120 W BREWSTER RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-9622
Practice Address - Country:US
Practice Address - Phone:724-496-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN356897L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered