Provider Demographics
NPI:1659040350
Name:BETTS, RONDELL
Entity Type:Individual
Prefix:
First Name:RONDELL
Middle Name:
Last Name:BETTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 JAMISON ST NE APT 450
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-4471
Mailing Address - Country:US
Mailing Address - Phone:202-227-1030
Mailing Address - Fax:
Practice Address - Street 1:3750 JAMISON ST NE APT 519
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4473
Practice Address - Country:US
Practice Address - Phone:202-210-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant