Individual
MS. JACQUELINE DENISE BETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 DICKERSON DR, VIDALIA, GA 30474-3826
(912) 538-8474
Mailing address
415 DICKERSON DR, VIDALIA, GA 30474-3826
(912) 538-8474
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN059040
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16
NURSING
GA
Enumeration date
01/30/2008
Last updated
01/30/2008
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