Provider Demographics
NPI:1821119678
Name:JEWETT, BETTY GENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:GENE
Last Name:JEWETT
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 1:9229 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1143
Mailing Address - Country:US
Mailing Address - Phone:330-908-1140
Mailing Address - Fax:
Practice Address - Street 1:9229 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1143
Practice Address - Country:US
Practice Address - Phone:330-908-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN035879164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse