Healthcare Provider Details

I. General information

NPI: 1891085494
Provider Name (Legal Business Name): NICOLE MICHELLE BETSON B.A., Q.M.H.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W CHARLESTON BLVD, #C23
LAS VEGAS NV
89102
US

IV. Provider business mailing address

7847 FALL HARVEST
LAS VEGAS NV
89147
US

V. Phone/Fax

Practice location:
  • Phone: 702-437-4673
  • Fax: 702-438-4673
Mailing address:
  • Phone: 425-350-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: