Provider Demographics
NPI:1790039436
Name:BETSINGER, JOAN ALICE (RN, BSN, IBCLC, ANLC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:ALICE
Last Name:BETSINGER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC, ANLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 HOUSTON ST NW STE 2
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MN
Mailing Address - Zip Code:55965-1094
Mailing Address - Country:US
Mailing Address - Phone:507-765-2647
Mailing Address - Fax:507-765-2139
Practice Address - Street 1:902 HOUSTON ST NW STE 2
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-1094
Practice Address - Country:US
Practice Address - Phone:507-765-2647
Practice Address - Fax:507-765-2139
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 72116-9163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant