Provider Demographics
NPI:1568562460
Name:BEEDLE, MARY ALLGAIER (MSN,APNP,FNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALLGAIER
Last Name:BEEDLE
Suffix:
Gender:F
Credentials:MSN,APNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2555
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1950
Mailing Address - Country:US
Mailing Address - Phone:541-915-5994
Mailing Address - Fax:
Practice Address - Street 1:306 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2208
Practice Address - Country:US
Practice Address - Phone:541-915-5994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA641482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227624Medicaid
OR381855Medicare ID - Type Unspecified
ORQ16256Medicare UPIN