Provider Demographics
NPI:1720725955
Name:PASS, BETTINA
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:
Last Name:PASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 OLD BROOKFIELD RD UNIT 10-1
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4033
Mailing Address - Country:US
Mailing Address - Phone:203-856-0232
Mailing Address - Fax:
Practice Address - Street 1:1918 BLACK ROCK TPKE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3543
Practice Address - Country:US
Practice Address - Phone:203-583-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner