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Contact Information

ELYSSA BETTENBROCK
508 E THREE NOTCH ST STE 100
ANDALUSIA, AL36420-3128
 Phone: 334-362-2015
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for ELYSSA BETTENBROCK · (Female)

NPI # 1871316984
Status Active
Credentials
Entity Individual
Enumeration date 11/06/2024
Last updated 11/25/2024 - More than a year ago
Sole proprietor 1 No
Identifiers
  • AL License # 3-002068
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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