MEDICARE: SHANETHA 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	363LF0000X	Family Nurse Practitioner	4704232658	MI

General Provider Information

NPI Number	:	1437349172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANETHA BETTS NP

Provider Business Mailing Address
First Line	:	7430 2ND AVE
Second Line	:	SUITE 210
City	:	DETROIT
State	:	MI
Zip	:	48202-2739
Country	:	US
Telephone Number	:	313-748-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 2ND AVE
Second Line	:	SUITE 210
City	:	DETROIT
State	:	MI
Zip	:	48202-2739
Country	:	US
Telephone Number	:	313-748-4200
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	04/28/2025

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