MEDICARE: KAREN A BETANCOURT RN

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	163WS0200X	School Registered Nurse	RN131590	MO

General Provider Information

NPI Number	:	1700218195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN A BETANCOURT RN

Provider Business Mailing Address
First Line	:	2550 W HAZELWOOD ST APT 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-3709
Country	:	US
Telephone Number	:	602-315-5178
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 W HAZELWOOD ST APT 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-3709
Country	:	US
Telephone Number	:	602-315-5178
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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