Provider Demographics
NPI:1699721340
Name:LABER, BETH M (CRNA)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:LABER
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:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:CO
Mailing Address - Zip Code:81047-0150
Mailing Address - Country:US
Mailing Address - Phone:719-537-0712
Mailing Address - Fax:719-537-6284
Practice Address - Street 1:4231 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1335
Practice Address - Country:US
Practice Address - Phone:719-537-0712
Practice Address - Fax:719-537-6284
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19867.736367500000X
CO73101367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311908OtherBLUE CROSS BLUE SHIELD
NE10024962200Medicaid
WY118032100Medicaid
WY311908OtherBLUE CROSS BLUE SHIELD
WYR19771Medicare UPIN
WYW9313Medicare ID - Type Unspecified