Provider Demographics
NPI:1053185033
Name:DEJAIFFE, BETTY WHEELER (LPN)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:WHEELER
Last Name:DEJAIFFE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:NY
Mailing Address - Zip Code:14801-1037
Mailing Address - Country:US
Mailing Address - Phone:607-590-8936
Mailing Address - Fax:
Practice Address - Street 1:5 NICHOLS RD UNIT 300
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:NY
Practice Address - Zip Code:14801-1037
Practice Address - Country:US
Practice Address - Phone:607-590-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315365164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty