Provider Demographics
NPI:1881807790
Name:DESJARLAIS, BETSY LYNN (FNP)
Entity type:Individual
Prefix:MISS
First Name:BETSY
Middle Name:LYNN
Last Name:DESJARLAIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 N 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1911
Mailing Address - Country:US
Mailing Address - Phone:719-963-0633
Mailing Address - Fax:
Practice Address - Street 1:3605 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7505
Practice Address - Country:US
Practice Address - Phone:602-427-0779
Practice Address - Fax:602-275-1716
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily