Provider Demographics
NPI:1780989707
Name:BETTS, LORRAINE
Entity type:Individual
Prefix:MISS
First Name:LORRAINE
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:23 BROOKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-4226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 POND VW
Practice Address - Street 2:
Practice Address - City:S SCHODACK
Practice Address - State:NY
Practice Address - Zip Code:12033-9750
Practice Address - Country:US
Practice Address - Phone:518-477-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY537618-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse