Provider Demographics
NPI:1942223375
Name:LOVE, BETTY LOUISE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:LOUISE
Last Name:LOVE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 JOE COLBY RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-6352
Mailing Address - Country:US
Mailing Address - Phone:580-762-5229
Mailing Address - Fax:
Practice Address - Street 1:3165 JOE COLBY RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-6352
Practice Address - Country:US
Practice Address - Phone:580-762-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0052750367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered