Provider Demographics
NPI:1700106531
Name:SHEETS, BETTYJO MAY
Entity Type:Individual
Prefix:
First Name:BETTYJO
Middle Name:MAY
Last Name:SHEETS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETTIE
Other - Middle Name:
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPM, LM, CLD
Mailing Address - Street 1:1750 E OCOTILLO RD
Mailing Address - Street 2:UNIT 23
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1043
Mailing Address - Country:US
Mailing Address - Phone:804-832-1439
Mailing Address - Fax:602-926-2377
Practice Address - Street 1:1750 E OCOTILLO RD
Practice Address - Street 2:UNIT 23
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1043
Practice Address - Country:US
Practice Address - Phone:804-832-1439
Practice Address - Fax:602-926-2377
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
VA0129000064176B00000X
AZLM185176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula