Healthcare Provider Details

I. General information

NPI: 1184495509
Provider Name (Legal Business Name): CHRISTY DIANNE BEITEL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E STATE ST
ITHACA NY
14850-4318
US

IV. Provider business mailing address

343 WHISPERING LAKE DR
SANTA ROSA BEACH FL
32459-4292
US

V. Phone/Fax

Practice location:
  • Phone: 888-458-1364
  • Fax:
Mailing address:
  • Phone: 256-426-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN9363955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: