MEDICARE: BETTY J CARREAUX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0002062998	VA

General Provider Information

NPI Number	:	1285782763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY J CARREAUX

Provider Business Mailing Address
First Line	:	7 WOODHAVEN RD
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23608-1509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	576 JEFFERSON AVE.
Second Line	:
City	:	FT. EUSTIS
State	:	VA
Zip	:	23604-5548
Country	:	US
Telephone Number	:	757-878-4755
Fax Number	:	757-878-4533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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