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Individual

MRS. WANDA SOCORRO BETANCOURT RIVERA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
2015 W WESTERN AVE STE 132, SOUTH BEND, IN 46619-3561
(574) 327-0140
Mailing address
2015 W WESTERN AVE, SUITE 132, SOUTH BEND, IN 46619-3544
(574) 229-8749
(574) 855-1915

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28217649A
IN
163WH0200X
Home Health Registered Nurse
28217649A
IN
163WI0500X
Infusion Therapy Registered Nurse
28217649A
IN
163WW0000X
Wound Care Registered Nurse
28217649A
IN
372600000X
Adult Companion
28217649A
IN
374U00000X
Home Health Aide
28217649A
IN
376J00000X
Homemaker
28217649A
IN
376K00000X
Nurse's Aide
28217649A
IN

Other

Enumeration date
05/24/2016
Last updated
06/15/2017
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