Individual
NICOLE CW BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
855 MANKATO AVE, WINONA, MN 55987-4868
(507) 454-3650
Mailing address
855 MANKATO AVE, WINONA, MN 55987-4868
(507) 454-3650
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
54044
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137511300
—
MN
01
—
P01098215
RAILROAD MEDICARE
MN
Enumeration date
05/17/2006
Last updated
01/22/2021
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