Individual
MICHELLE MARIE BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-4814
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
684786
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP111738
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1532517-02
—
TX
05
—
308753100
—
FL
01
—
84414U
BLUE SHIELD
TX
01
—
G4398
BLUE CROSS BLUE SHIELD
FL
01
—
P00198582
RR/MEDICARE
TX
Enumeration date
04/06/2006
Last updated
12/07/2021
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