Provider Demographics
NPI:1902810252
Name:BETTIGA, ELAINE K (FNP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:K
Last Name:BETTIGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:K
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:670 9TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6248
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:3304 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-7102
Practice Address - Country:US
Practice Address - Phone:707-725-4477
Practice Address - Fax:707-725-9209
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP10968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN402554OtherSTATE LICENSE
CAFNP10968OtherSTATE LICENSE