Individual
MR. GEOFFERY BEATTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-5000
Mailing address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
041323569
IL
163WE0003X
Emergency Registered Nurse
Primary
041-323569
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041-323569
IDPR
IL
Enumeration date
09/14/2007
Last updated
06/27/2014
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