Provider Demographics
NPI:1669856035
Name:GUNTER, BETTY (LPN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:GUNTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 E 1095 RD
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-5050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 E RAY FINE BLVD STE 6
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5381
Practice Address - Country:US
Practice Address - Phone:918-503-6235
Practice Address - Fax:918-503-6239
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL030492164W00000X
OK29631164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse