Provider Demographics
NPI:1649519794
Name:DANIELS, BETTY JEAN (CERTIFIED MED TECH)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JEAN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CERTIFIED MED TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-3041
Mailing Address - Country:US
Mailing Address - Phone:414-628-3853
Mailing Address - Fax:
Practice Address - Street 1:2514 N 36TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-3041
Practice Address - Country:US
Practice Address - Phone:414-628-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-09
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINA205392171M00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor