Healthcare Provider Details

I. General information

NPI: 1255809000
Provider Name (Legal Business Name): GERALDINE ANNE LOUGHRAN-BEUTLER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9941 HOT SPRINGS DR
HUNTINGTON BEACH CA
92646
US

IV. Provider business mailing address

9941 HOT SPRINGS DR
HUNTINGTON BEACH CA
92646-5329
US

V. Phone/Fax

Practice location:
  • Phone: 562-900-0258
  • Fax:
Mailing address:
  • Phone: 562-900-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number423518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number6475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: