Provider Demographics
NPI:1881904001
Name:QUATTLEBAUM, BETTY JOANNE (LPN)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JOANNE
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3130
Mailing Address - Country:US
Mailing Address - Phone:440-960-2237
Mailing Address - Fax:
Practice Address - Street 1:4519 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3130
Practice Address - Country:US
Practice Address - Phone:440-960-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH088905164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse