Provider Demographics
NPI:1538823323
Name:BEATTY, MARCELA PATRICIA (RN)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:PATRICIA
Last Name:BEATTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARCELA
Other - Middle Name:PATRICIA
Other - Last Name:VILLEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1032 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4173
Mailing Address - Country:US
Mailing Address - Phone:520-834-7748
Mailing Address - Fax:
Practice Address - Street 1:280 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1646439163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology