Provider Demographics
NPI:1689902462
Name:WASHINGTON, BETTY V (LPN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:V
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WILLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-2310
Mailing Address - Country:US
Mailing Address - Phone:334-538-2062
Mailing Address - Fax:334-262-1628
Practice Address - Street 1:105 WILLOW OAK DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-2310
Practice Address - Country:US
Practice Address - Phone:334-538-2062
Practice Address - Fax:334-262-1628
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-057851332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies