Healthcare Provider Details

I. General information

NPI: 1013570738
Provider Name (Legal Business Name): BRENDA SUSAN BEUTEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PLEASANT ST
AU SABLE FORKS NY
12912
US

IV. Provider business mailing address

1302 CHARLESGATE CIR
EAST AMHERST NY
14051-1285
US

V. Phone/Fax

Practice location:
  • Phone: 518-647-8164
  • Fax:
Mailing address:
  • Phone: 716-909-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343313-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: