| NPI | 1053505362 |
|---|---|
| Former Name | MARY M. BEATTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 3195) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 3195-033) |
| 163W00000X Registered Nurse (Licence: WI 107505-030) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2013-08-26 |