Healthcare Provider Details

I. General information

NPI: 1093795049
Provider Name (Legal Business Name): BETTY ANN ULMER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827, BOX 203
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827, BOX 203
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 340-353-2724
  • Fax:
Mailing address:
  • Phone: 340-353-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number656445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: