Healthcare Provider Details

I. General information

NPI: 1730300898
Provider Name (Legal Business Name): BETTY DOLORES HORINEK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E CHESTNUT AVE
PONCA CITY OK
74601-4311
US

IV. Provider business mailing address

2008 HUNTINGTON PL
PONCA CITY OK
74604-1523
US

V. Phone/Fax

Practice location:
  • Phone: 580-763-6017
  • Fax: 580-763-6059
Mailing address:
  • Phone: 580-762-7662
  • Fax: 580-762-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR0053696
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: