Betty Joanne Quattlebaum, L.P.N.

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

088905 Issued in OH

Practice address

4519 Briarwood Dr
Lorain, OH 44053-3130

Phone

(440) 960-2237

NPI assigned

Oct 21, 2010

Last updated

Oct 21, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1287619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287619200000",
    "number": "1881904001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4519 BRIARWOOD DR",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440533130",
            "telephone_number": "440-960-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4519 BRIARWOOD DR",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440533130",
            "telephone_number": "440-960-2237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUATTLEBAUM",
        "first_name": "BETTY",
        "middle_name": "JOANNE",
        "name_prefix": "Ms.",
        "credential": "L.P.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-21",
        "last_updated": "2010-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "088905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Lorain, OH
• Providers in Lorain, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; 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.