Betty Jean Nixdorf

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN107638L Issued in PA

Practice address

212 Willow Valley Lakes Dr Ste 208
Willow Street, PA 17584-9668

Phone

(717) 740-4434

Fax

(717) 740-4453

NPI assigned

Mar 19, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1871052829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 WILLOW VALLEY LAKES DR STE 208",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849668",
            "telephone_number": "717-740-4434",
            "fax_number": "717-740-4453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 WILLOW VALLEY LAKES DR STE 208",
            "city": "WILLOW STREET",
            "state": "PA",
            "postal_code": "175849668",
            "telephone_number": "717-740-4434",
            "fax_number": "717-740-4453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIXDORF",
        "first_name": "BETTY JEAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-19",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN107638",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN107638L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Willow Street, PA
• Providers in Willow Street, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; 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.