Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 04-15910 | KS |
Y | 2084N0400X | Neurologist | R5844 | MO |
NPI | 1003854548 |
---|---|
Provider Name | Dr. Irene E Bettinger |
First Address | Kansas City, MO 64111-3342 |
Second Address | Kansas City, MO 64111-3342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 16/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03385075 | BLUE CROSS BLUE SHIELD (01) | |
100350910B | (05) | KS |
100350910C | (05) | KS |
4001299 | AETNA (01) | |
C50244 | (02) |