Provider Demographics
NPI:1770374571
Name:BEEDLE, ANGELA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BEEDLE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PELISSERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10057 E LOMITA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-1247
Mailing Address - Country:US
Mailing Address - Phone:480-516-8257
Mailing Address - Fax:480-516-8257
Practice Address - Street 1:10057 E LOMITA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-1247
Practice Address - Country:US
Practice Address - Phone:480-516-8257
Practice Address - Fax:480-516-8257
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL316856163WL0100X
AZRN194792163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant