Healthcare Provider Details

I. General information

NPI: 1154051407
Provider Name (Legal Business Name): BETSY THOMAS-NASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 CECIL MALONE DR
ITHACA NY
14850-5124
US

IV. Provider business mailing address

138 CECIL MALONE DR
ITHACA NY
14850-5124
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-0466
  • Fax: 607-277-1494
Mailing address:
  • Phone: 607-273-0466
  • Fax: 607-277-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number770334-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: