Provider Demographics
NPI:1720123128
Name:ARNOLD, BETTY L (MA)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 N FRONTAGE RD
Mailing Address - Street 2:SPACE #204
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-7131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25950 W. ROCKAWAY HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85342-0098
Practice Address - Country:US
Practice Address - Phone:623-388-2336
Practice Address - Fax:623-388-9368
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor