Provider Demographics
NPI:1013260330
Name:BETANCOURT, LAURA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BETANCOURT
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 1:2181 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2430
Mailing Address - Country:US
Mailing Address - Phone:602-381-4671
Mailing Address - Fax:
Practice Address - Street 1:2181 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2430
Practice Address - Country:US
Practice Address - Phone:602-381-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program