MEDICARE: BETTYJO MAY SHEETS

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	374J00000X	Doula
2	176B00000X	Midwife	0129000064	VA
3	176B00000X	Midwife	LM185	AZ

General Provider Information

NPI Number	:	1700106531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTYJO MAY SHEETS

Provider Business Mailing Address
First Line	:	1750 E OCOTILLO RD
Second Line	:	UNIT 23
City	:	PHOENIX
State	:	AZ
Zip	:	85016-1043
Country	:	US
Telephone Number	:	804-832-1439
Fax Number	:	602-926-2377

Provider Business Practice Location Address
First Line	:	1750 E OCOTILLO RD
Second Line	:	UNIT 23
City	:	PHOENIX
State	:	AZ
Zip	:	85016-1043
Country	:	US
Telephone Number	:	804-832-1439
Fax Number	:	602-926-2377

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	04/12/2016

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