Healthcare Provider Details

I. General information

NPI: 1194220350
Provider Name (Legal Business Name): BEVERLY BETTINGER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732S MAIN ST
TOLEDO OH
43605-2338
US

IV. Provider business mailing address

1117 CLARK ST
HOLLAND OH
43528-8766
US

V. Phone/Fax

Practice location:
  • Phone: 419-691-0601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN257208
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: