Provider Demographics
NPI:1932897667
Name:BETT, MARY ANN (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BULARD
Other - Last Name:BETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:5 COPPER DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-5067
Mailing Address - Country:US
Mailing Address - Phone:817-851-8859
Mailing Address - Fax:
Practice Address - Street 1:5 COPPER DR
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-5067
Practice Address - Country:US
Practice Address - Phone:817-851-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95312791163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse