Healthcare Provider Details

I. General information

NPI: 1770374571
Provider Name (Legal Business Name): ANGELA BEEDLE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA PELISSERO

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10057 E LOMITA AVE
MESA AZ
85209-1247
US

IV. Provider business mailing address

10057 E LOMITA AVE
MESA AZ
85209-1247
US

V. Phone/Fax

Practice location:
  • Phone: 480-516-8257
  • Fax: 480-516-8257
Mailing address:
  • Phone: 480-516-8257
  • Fax: 480-516-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL316856
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN194792
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: