Provider Demographics
NPI:1770174609
Name:BEAUDET, HALEY (NP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:BEAUDET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 W 3RD ST APT 328
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1639
Mailing Address - Country:US
Mailing Address - Phone:530-739-9198
Mailing Address - Fax:
Practice Address - Street 1:1704 W MANCHESTER AVE STE 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3056
Practice Address - Country:US
Practice Address - Phone:323-778-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily