Provider Demographics
NPI:1174758148
Name:BEALE, LORI R (CNM, MSN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:R
Last Name:BEALE
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S TRIVIZ DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-0605
Mailing Address - Country:US
Mailing Address - Phone:575-522-9793
Mailing Address - Fax:575-532-9019
Practice Address - Street 1:2100 S TRIVIZ DR
Practice Address - Street 2:SUITE H
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-0605
Practice Address - Country:US
Practice Address - Phone:575-522-9793
Practice Address - Fax:575-532-9019
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508545367A00000X
NM650367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife