Provider Demographics
NPI:1982747861
Name:CHUCULATE, BETTY JEAN (RN)
Entity Type:Individual
Prefix:
First Name:BETTY JEAN
Middle Name:
Last Name:CHUCULATE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 1265 SOUTH UTICA STE. 100N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4090
Mailing Address - Country:US
Mailing Address - Phone:918-579-3385
Mailing Address - Fax:
Practice Address - Street 1:1265 SOUTH UTICA STE. 100N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4090
Practice Address - Country:US
Practice Address - Phone:918-579-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK385133VN1006X
OK45672163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator