Healthcare Provider Details

I. General information

NPI: 1578737359
Provider Name (Legal Business Name): LAURA BEEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA BRINK

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PRISON ROAD CSP SACRAMENTO,
FOLSOM CA
95671
US

IV. Provider business mailing address

2739 ROYAL PARK DR
CAMERON PARK CA
95682-9215
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-8610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number673258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: