Provider Demographics
NPI:1215536867
Name:BEETER, MISSY MARIE
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:MARIE
Last Name:BEETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST N # 86
Mailing Address - Street 2:
Mailing Address - City:VELVA
Mailing Address - State:ND
Mailing Address - Zip Code:58790-7206
Mailing Address - Country:US
Mailing Address - Phone:701-509-7196
Mailing Address - Fax:
Practice Address - Street 1:1816 MAIN ST S APT 44
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6544
Practice Address - Country:US
Practice Address - Phone:701-822-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14800653747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant