MEDICARE: MRS. LORI R BEALE C.N.M, M.S.N.

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	367A00000X	Advanced Practice Midwife	508545	TX
2	367A00000X	Advanced Practice Midwife	650	NM

General Provider Information

NPI Number	:	1174758148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI R BEALE C.N.M, M.S.N.

Provider Business Mailing Address
First Line	:	2100 S TRIVIZ DR
Second Line	:	SUITE H
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-0605
Country	:	US
Telephone Number	:	575-522-9793
Fax Number	:	575-532-9019

Provider Business Practice Location Address
First Line	:	2100 S TRIVIZ DR
Second Line	:	SUITE H
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-0605
Country	:	US
Telephone Number	:	575-522-9793
Fax Number	:	575-532-9019

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/11/2013

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Directions to “ MRS. LORI R BEALE C.N.M, M.S.N.” Practice Location

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