Individual provider Active NPI

Betty Jane Tovar, RN, PHN

  • Pediatric Registered Nurse
  • Boulder, CO
National Provider Identifier
1578765871
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Registered NurseTaxonomy code 163WP0200X
License
RN626267 Issued in CA
Practice address
3450 Broadway St
Boulder, CO 80304-1824
Phone
(626) 744-6005
NPI assigned
May 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X RN626267 CA Primary

Addresses

Primary practice location

3450 Broadway St
Boulder, CO 80304-1824

Mailing address

3450 Broadway
Boulder, CO 80304
Phone (626) 786-9560

Other identifiers 1

IdentifierTypeStateIssuer
RN626267OtherCAREGISTERED NURSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN626267CAMDPediatric Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436400000000",
    "number": "1578765871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 BROADWAY",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80304",
            "telephone_number": "626-786-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803041824",
            "telephone_number": "626-744-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOVAR",
        "first_name": "BETTY",
        "middle_name": "JANE",
        "credential": "RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2015-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "CA",
            "license": "RN626267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "RN626267",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.