Provider Demographics
NPI:1689888729
Name:GOETZ, BETSY LYNN
Entity Type:Individual
Prefix:MISS
First Name:BETSY
Middle Name:LYNN
Last Name:GOETZ
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 1:5547 DODSWORTH LN
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-3537
Mailing Address - Country:US
Mailing Address - Phone:859-801-8941
Mailing Address - Fax:
Practice Address - Street 1:5547 DODSWORTH LN
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-3537
Practice Address - Country:US
Practice Address - Phone:859-801-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist