Provider Demographics
NPI:1689909863
Name:HERNANDEZ, BETSY WRAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:WRAY
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:WRAY
Other - Last Name:BOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3046 SHERWOOD RD.
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522
Mailing Address - Country:US
Mailing Address - Phone:315-597-3514
Mailing Address - Fax:
Practice Address - Street 1:3046 SHERWOOD RD.
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522
Practice Address - Country:US
Practice Address - Phone:315-597-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604950163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care