Provider Demographics
NPI:1841406931
Name:BETTS, STANLEY CARLTON JR (RN)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:CARLTON
Last Name:BETTS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 PINE CREST DR
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6037
Mailing Address - Country:US
Mailing Address - Phone:216-780-3549
Mailing Address - Fax:
Practice Address - Street 1:4000 PINE CREST DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6037
Practice Address - Country:US
Practice Address - Phone:216-780-3549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN - 298464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304607Medicaid