Healthcare Provider Details

I. General information

NPI: 1841758224
Provider Name (Legal Business Name): SANDRA BEALE RN, IBCLC, ICCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 CEDAR HILL RD
WHITEFISH MT
59937-7955
US

IV. Provider business mailing address

278 CEDAR HILL RD
WHITEFISH MT
59937-7955
US

V. Phone/Fax

Practice location:
  • Phone: 406-261-9091
  • Fax:
Mailing address:
  • Phone: 406-261-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberNUR-RN-LIC-40554
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: