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NPI Code Detail

MEDICARE: MS. MARY M BEUTNER R.N.

MEDICARE: MS. MARY M BEUTNER R.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
1163WD0400XDiabetes Educator Registered Nurse300620CA

General Provider Information

NPI Number : 1538392618
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY M BEUTNER R.N.
Provider Business Mailing Address
First Line : 201 WALNUT AVE
Second Line :
City : VALLEJO
State : CA
Zip : 94592-1107
Country : US
Telephone Number : 707-437-1811
Fax Number : 707-437-1809
Provider Business Practice Location Address
First Line : 201 WALNUT AVE
Second Line :
City : VALLEJO
State : CA
Zip : 94592-1107
Country : US
Telephone Number : 707-437-1811
Fax Number : 707-437-1813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2009
Last Update Date : 08/24/2009

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