MEDICARE: MRS. BEVERLY JEAN NASH RN

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	163W00000X	Registered Nurse	396258-1	NY

General Provider Information

NPI Number	:	1396296802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY JEAN NASH RN

Provider Business Mailing Address
First Line	:	4328 DEREIMER AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466
Country	:	US
Telephone Number	:	347-346-9759
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 DEREIMER AVE.
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-1820
Country	:	US
Telephone Number	:	347-346-9759
Fax Number	:

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

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	10/19/2016

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