Individual
KATHLEEN DENISE BEAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-2440
(909) 580-2441
Mailing address
PO BOX 765, COLTON, CA 92324-0007
(909) 580-2440
(909) 783-9112
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN247952
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430079038
RAILROAD MEDICARE
—
05
—
RN2479520
—
CA
Enumeration date
12/13/2005
Last updated
04/17/2013
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