1972959435 NPI number — DEBORAH BETSWORTH PHD

Table of content: DEBORAH BETSWORTH PHD (NPI 1972959435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972959435 NPI number — DEBORAH BETSWORTH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETSWORTH
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972959435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 W GREEN TREE RD, 119
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-573-5715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
IOWA CITY VA HEALTH CARE SYSTEM
Provider Second Line Business Practice Location Address:
601 HWY 6 WEST
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-573-5715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  2119-57 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC1900X , with the licence number: 2119-57 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)