Individual
PHILANA NIKITA BETONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10 MILES E. OF TEESTO CHAPTER BIA RD. N-9062, WINSLOW, AZ 86047-7202
(928) 613-7069
Mailing address
P.O. BOX 7202 CPU TEESTO, WINSLOW, AZ 86047-7202
(928) 613-7069
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
AZ
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
AZ
Other
Enumeration date
04/15/2016
Last updated
08/27/2019
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