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NPI Code Detail

MEDICARE: BETTY JEAN HATHAWAY

MEDICARE: BETTY JEAN HATHAWAY
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1669944492
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY JEAN HATHAWAY
Provider Business Mailing Address
First Line : 1250 SANDSTONE DR
Second Line :
City : WELLINGTON
State : NV
Zip : 89444-9437
Country : US
Telephone Number : 775-781-1675
Fax Number :
Provider Business Practice Location Address
First Line : 1290 TAVERN RD
Second Line :
City : MAMMOTH LAKES
State : CA
Zip : 93546-6601
Country : US
Telephone Number : 760-924-1740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2018
Last Update Date : 11/29/2023

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