Provider Demographics
NPI:1447643317
Name:BETLEY, BONNIE
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BETLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E BUNNELL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7844
Mailing Address - Country:US
Mailing Address - Phone:907-235-8857
Mailing Address - Fax:907-235-7090
Practice Address - Street 1:195 E BUNNELL AVE STE C
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7844
Practice Address - Country:US
Practice Address - Phone:907-235-8857
Practice Address - Fax:907-235-7090
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10313163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse