Provider Demographics
NPI:1659773232
Name:BETANCES, MARIAN MICHELLE
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:MICHELLE
Last Name:BETANCES
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 1:1313 FOXVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2802
Mailing Address - Country:US
Mailing Address - Phone:484-554-7831
Mailing Address - Fax:
Practice Address - Street 1:1313 FOXVIEW DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2802
Practice Address - Country:US
Practice Address - Phone:484-554-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA253Z00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide