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NPI Code Detail

MEDICARE: GWENDOLYN LEE BEETLE FNP

MEDICARE:   GWENDOLYN LEE BEETLE  FNP
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
1163W00000XRegistered Nurse603569NY
2363LF0000XFamily Nurse PractitionerF336166NY

General Provider Information

NPI Number : 1578872156
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN LEE BEETLE FNP
Provider Business Mailing Address
First Line : 123 W 86TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10024-3419
Country : US
Telephone Number : 212-877-2833
Fax Number : 212-362-7080
Provider Business Practice Location Address
First Line : 123 W 86TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10024-3419
Country : US
Telephone Number : 212-877-2833
Fax Number : 212-362-7080
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2010
Last Update Date : 09/30/2010

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