Healthcare Provider Details

I. General information

NPI: 1114076148
Provider Name (Legal Business Name): BETTY A GWINN-HALL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTY A STURTZ CNP

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S 15TH ST STE 102
COSHOCTON OH
43812-1874
US

IV. Provider business mailing address

1200 S 16TH ST
COSHOCTON OH
43812-2754
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-7144
  • Fax: 740-622-7166
Mailing address:
  • Phone: 740-622-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP-05751
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: