Provider Demographics
NPI:1689857963
Name:AULT, BETTY JANE (LPN)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JANE
Last Name:AULT
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 1:1290 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4437
Mailing Address - Country:US
Mailing Address - Phone:740-297-4320
Mailing Address - Fax:
Practice Address - Street 1:1290 MOORE ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4437
Practice Address - Country:US
Practice Address - Phone:740-297-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-113474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse