Provider Demographics
NPI:1356061675
Name:ULMER, BETTY JANE (RN)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JANE
Last Name:ULMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 E 1350 AVE
Mailing Address - Street 2:
Mailing Address - City:MULBERRY GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:62262-3498
Mailing Address - Country:US
Mailing Address - Phone:618-980-5623
Mailing Address - Fax:618-326-8482
Practice Address - Street 1:801 W WALL ST
Practice Address - Street 2:
Practice Address - City:MULBERRY GROVE
Practice Address - State:IL
Practice Address - Zip Code:62262-1049
Practice Address - Country:US
Practice Address - Phone:618-326-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041335361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse