Provider Demographics
NPI:1841758224
Name:BEALE, SANDRA (RN, IBCLC, ICCE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BEALE
Suffix:
Gender:F
Credentials:RN, IBCLC, ICCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7955
Mailing Address - Country:US
Mailing Address - Phone:406-261-9091
Mailing Address - Fax:
Practice Address - Street 1:278 CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7955
Practice Address - Country:US
Practice Address - Phone:406-261-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-40554163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant