Provider Demographics
NPI:1598959579
Name:NEZERKA, BETTY A
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:NEZERKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 ROGERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:IA
Mailing Address - Zip Code:52227-9722
Mailing Address - Country:US
Mailing Address - Phone:319-848-4619
Mailing Address - Fax:319-848-4604
Practice Address - Street 1:422 ROGERS GROVE RD
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:IA
Practice Address - Zip Code:52227-9722
Practice Address - Country:US
Practice Address - Phone:319-848-4619
Practice Address - Fax:319-848-4604
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX00786681Medicaid