Provider Demographics
NPI:1184495509
Name:BEITEL, CHRISTY DIANNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DIANNE
Last Name:BEITEL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 WHISPERING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4292
Mailing Address - Country:US
Mailing Address - Phone:256-426-9552
Mailing Address - Fax:
Practice Address - Street 1:314 E STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4318
Practice Address - Country:US
Practice Address - Phone:888-458-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9363955163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant