Provider Demographics
NPI:1700218195
Name:BETANCOURT, KAREN A (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:BETANCOURT
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 1:2550 W HAZELWOOD ST APT 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-3709
Mailing Address - Country:US
Mailing Address - Phone:602-315-5178
Mailing Address - Fax:
Practice Address - Street 1:2550 W HAZELWOOD ST APT 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-3709
Practice Address - Country:US
Practice Address - Phone:602-315-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN131590163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool