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Individual

BETSY LUCILLE VAN HAAFTEN

Active
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Individual

BETSY LUCILLE VAN HAAFTEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
106508
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
106508
PA LICENSE
IA
01
1774847
PA CERTIFICATION NUMBER
01
362EA3363
DRIVER'S LISENCE
IA
Enumeration date
01/27/2021
Last updated
01/11/2023
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