Healthcare Provider Details

I. General information

NPI: 1972814952
Provider Name (Legal Business Name): MS. BETTIE ANE JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 W 105TH ST APT 2EF
NEW YORK NY
10025-4039
US

IV. Provider business mailing address

161 W 105TH ST APT 2EF
NEW YORK NY
10025-4039
US

V. Phone/Fax

Practice location:
  • Phone: 212-662-8840
  • Fax:
Mailing address:
  • Phone: 212-662-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: