Provider Demographics
NPI:1063807907
Name:BEATTY, DEBRA ANN (RN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:BEATTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22349 LA PALMA AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3823
Mailing Address - Country:US
Mailing Address - Phone:714-269-0765
Mailing Address - Fax:
Practice Address - Street 1:22349 LA PALMA AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3823
Practice Address - Country:US
Practice Address - Phone:714-602-9910
Practice Address - Fax:714-602-7150
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA615967163WA0400X, 163WC0400X, 163WG0600X, 163WN1003X, 163WP0809X, 163WP2201X, 163WW0101X, 163WX0106X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No174H00000XOther Service ProvidersHealth Educator