Healthcare Provider Details

I. General information

NPI: 1588615900
Provider Name (Legal Business Name): DAVID ANTHONY BETTS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/01/2023
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE LANE
CHARLOTTE NC
28204
US

IV. Provider business mailing address

PO BOX 601549
CHARLOTTE NC
28260-1549
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-4274
  • Fax: 704-316-9771
Mailing address:
  • Phone: 704-384-4274
  • Fax: 704-316-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number070666
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number034925
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9324363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: