MEDICARE: BONNIE SUE BETTS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	811300	NV
2	363LW0102X	Women's Health Nurse Practitioner	15404	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	811300	OTHER	NV	APRN-CNP LICENSE
2	442981	OTHER	CA	RN LICENSE

General Provider Information

NPI Number	:	1083852206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE SUE BETTS NP

Provider Business Mailing Address
First Line	:	1815 E LAKE MEAD BLVD STE 215
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7190
Country	:	US
Telephone Number	:	702-818-1919
Fax Number	:	702-399-5499

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD STE 215
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7190
Country	:	US
Telephone Number	:	702-818-1919
Fax Number	:	702-399-5499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	12/12/2025

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Directions to “ BONNIE SUE BETTS NP” Practice Location

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