MEDICARE: MRS. CHRISTIE JEANNE BEATTIE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP-973A	ID

General Provider Information

NPI Number	:	1164734240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTIE JEANNE BEATTIE NP-C

Provider Business Mailing Address
First Line	:	3668 N HARBOR LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6914
Country	:	US
Telephone Number	:	800-230-7526
Fax Number	:	208-376-9444

Provider Business Practice Location Address
First Line	:	3668 N HARBOR LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6914
Country	:	US
Telephone Number	:	800-230-7526
Fax Number	:	208-376-9444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/06/2010

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