Healthcare Provider Details

I. General information

NPI: 1730605767
Provider Name (Legal Business Name): BETTY WADLEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETTY WADLEY RN

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 GRAND ISLE DRIVE
BRANDON FL
33511
US

IV. Provider business mailing address

1951 GRAND ISLE DR
BRANDON FL
33511-4787
US

V. Phone/Fax

Practice location:
  • Phone: 306-547-4682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9447627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: