Provider Demographics
NPI:1669837829
Name:BEUTLER, ANEESA MALOUF (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANEESA
Middle Name:MALOUF
Last Name:BEUTLER
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 1:74 S HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83286-5000
Mailing Address - Country:US
Mailing Address - Phone:435-554-1098
Mailing Address - Fax:
Practice Address - Street 1:74 S HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:ID
Practice Address - Zip Code:83286-5000
Practice Address - Country:US
Practice Address - Phone:435-554-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL-86712163WL0100X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant