Provider Demographics
NPI:1427306257
Name:BETANCOURT, JACQUELINE EUGENIA
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:EUGENIA
Last Name:BETANCOURT
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 1:2009 TREETOP LN APT 42
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7687
Mailing Address - Country:US
Mailing Address - Phone:301-257-2536
Mailing Address - Fax:
Practice Address - Street 1:2009 TREETOP LN APT 42
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7687
Practice Address - Country:US
Practice Address - Phone:301-257-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide