Provider Demographics
NPI:1851891246
Name:MCCALL, BETTY KAYE X (LPN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:KAYE
Last Name:MCCALL
Suffix:X
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:KAYE
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3948 W FREMONT RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-9817
Mailing Address - Country:US
Mailing Address - Phone:419-271-0230
Mailing Address - Fax:
Practice Address - Street 1:3948 W FREMONT RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-9817
Practice Address - Country:US
Practice Address - Phone:419-271-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.104618.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse