Healthcare Provider Details

I. General information

NPI: 1174022396
Provider Name (Legal Business Name): DORA CAREW JOHN-BETTS CRNP-FAMILY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 NATIONAL HWY
LAVALE MD
21502-7356
US

IV. Provider business mailing address

957 NATIONAL HWY
LAVALE MD
21502-7356
US

V. Phone/Fax

Practice location:
  • Phone: 240-362-7128
  • Fax: 240-362-7129
Mailing address:
  • Phone: 301-729-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR180311
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: