Healthcare Provider Details

I. General information

NPI: 1003170275
Provider Name (Legal Business Name): LATOYA BETTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GRAND CONCOURSE
BRONX NY
10453-4303
US

IV. Provider business mailing address

1434 WILLIAMSBRIDGE RD
BRONX NY
10461-2507
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-7295
  • Fax: 718-299-6797
Mailing address:
  • Phone: 718-618-0401
  • Fax: 347-479-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646922
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343094
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: