Basic Information
Provider Information
NPI: 1699188839
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEUTLER
FirstName: ELIZABETH
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7391 W CHARLESTON BLVD
Address2: SUITE 140
City: LAS VEGAS
State: NV
PostalCode: 891171501
CountryCode: US
TelephoneNumber: 7023042144
FaxNumber: 7023042147
Practice Location
Address1: 7391 W CHARLESTON BLVD
Address2: SUITE 140
City: LAS VEGAS
State: NV
PostalCode: 891171501
CountryCode: US
TelephoneNumber: 7023042144
FaxNumber: 7023042147
Other Information
ProviderEnumerationDate: 06/05/2014
LastUpdateDate: 11/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPRN001726NVY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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