Healthcare Provider Details

I. General information

NPI: 1528278074
Provider Name (Legal Business Name): ELEANE MARIE BEADLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELEANE LIESEMER

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-6661
  • Fax: 253-968-5926
Mailing address:
  • Phone: 808-433-6661
  • Fax: 253-968-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24031
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number24031
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: