Provider Demographics
NPI:1811394125
Name:BEATTY, TAMELA
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:
Last Name:BEATTY
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 1:235 LUTZ LN
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7927
Mailing Address - Country:US
Mailing Address - Phone:570-726-4306
Mailing Address - Fax:570-726-4082
Practice Address - Street 1:7930 NITTANY VALLEY DR
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-8805
Practice Address - Country:US
Practice Address - Phone:570-726-4306
Practice Address - Fax:570-726-4082
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN256848L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse