Provider Demographics
NPI:1730431123
Name:CALDWELL, BETTY C (NP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:C
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18263 E 10 MILE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-5805
Mailing Address - Country:US
Mailing Address - Phone:586-778-4952
Mailing Address - Fax:
Practice Address - Street 1:18263 E 10 MILE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-778-4952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252642363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care