Provider Demographics
NPI:1619049897
Name:BETITA, MARY JANETTE (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANETTE
Last Name:BETITA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W. CHARLESTON BLVD. STE. 508
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-3982
Mailing Address - Fax:702-671-6595
Practice Address - Street 1:5785 CENTENNIAL CENTER BLVD. STE. 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149
Practice Address - Country:US
Practice Address - Phone:702-383-2273
Practice Address - Fax:702-366-0570
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN000884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily