Healthcare Provider Details

I. General information

NPI: 1538392618
Provider Name (Legal Business Name): MARY M BEUTNER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WALNUT AVE
VALLEJO CA
94592-1107
US

IV. Provider business mailing address

201 WALNUT AVE
VALLEJO CA
94592-1107
US

V. Phone/Fax

Practice location:
  • Phone: 707-437-1811
  • Fax: 707-437-1813
Mailing address:
  • Phone: 707-437-1811
  • Fax: 707-437-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number300620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: