Provider Demographics
NPI:1194504670
Name:MCDONALD, BETTY SHARLEAN
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:SHARLEAN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24919 S 4420 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-5529
Mailing Address - Country:US
Mailing Address - Phone:918-256-9210
Mailing Address - Fax:
Practice Address - Street 1:24919 S 4420 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-5529
Practice Address - Country:US
Practice Address - Phone:918-256-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator