Provider Demographics
NPI:1538780747
Name:DEMKO, BETTY ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
Last Name:DEMKO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:3920 ST FRANCIS WAY STE 220
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4922
Practice Address - Country:US
Practice Address - Phone:765-775-2800
Practice Address - Fax:765-471-5461
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28163254A163WI0600X
IN71010076A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control