Provider Demographics
NPI:1255809000
Name:LOUGHRAN-BEUTLER, GERALDINE ANNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ANNE
Last Name:LOUGHRAN-BEUTLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9941 HOT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5329
Mailing Address - Country:US
Mailing Address - Phone:562-900-0258
Mailing Address - Fax:
Practice Address - Street 1:9941 HOT SPRINGS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646
Practice Address - Country:US
Practice Address - Phone:562-900-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423518163WW0000X
CA6475363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WW0000XNursing Service ProvidersRegistered NurseWound Care