MEDICARE: MS. SHAVON MONIQUE BEAMAN NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	AG10200170	CA

General Provider Information

NPI Number	:	1033712435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAVON MONIQUE BEAMAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	910 N DWIGHT AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-1608
Country	:	US
Telephone Number	:	310-714-0734
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 N DWIGHT AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-1608
Country	:	US
Telephone Number	:	310-714-0734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	02/05/2026

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