Healthcare Provider Details

I. General information

NPI: 1184809204
Provider Name (Legal Business Name): JUDY GAYLE BEASLEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E HAZELTON AVE
STOCKTON CA
95205-6229
US

IV. Provider business mailing address

1402 KEAGLE WAY
LODI CA
95242-3560
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-3879
  • Fax: 209-468-8222
Mailing address:
  • Phone: 209-369-5971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number257917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: