Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 57-049 | WI |
NPI | 1144588898 |
---|---|
Provider Name | Tavniah Leigh Betts |
First Address | Viroqua, WI 54665-1931 |
Second Address | Viroqua, WI 54665-1931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2012 |
Last Update Date | 01/05/2012 |