Provider Demographics
NPI:1104231034
Name:DELONG, BETTY (NP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:DELONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4441 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9359
Mailing Address - Country:US
Mailing Address - Phone:269-788-6888
Mailing Address - Fax:269-788-9889
Practice Address - Street 1:358 E CHICAGO ST
Practice Address - Street 2:SUITE 203
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2072
Practice Address - Country:US
Practice Address - Phone:517-278-9364
Practice Address - Fax:517-278-3966
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704177255363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner