MEDICARE: BEVERLY C. TITUS N.P.

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	71000372A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538160775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY C. TITUS N.P.

Provider Business Mailing Address
First Line	:	8777 BROADWAY
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-7035
Country	:	US
Telephone Number	:	219-736-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	8777 BROADWAY
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-7035
Country	:	US
Telephone Number	:	219-736-5151
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/16/2013

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