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NPI Code Detail

MEDICARE: VIVIAN BEADLES RN

MEDICARE: VIVIAN BEADLES 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
1163W00000XRegistered Nurse041235154IL

General Provider Information

NPI Number : 1639437106
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIVIAN BEADLES RN
Provider Business Mailing Address
First Line : PO BOX 155
Second Line :
City : CHRISTOPHER
State : IL
Zip : 62822-0155
Country : US
Telephone Number : 618-724-2436
Fax Number :
Provider Business Practice Location Address
First Line : 209 NW 11TH ST
Second Line :
City : FAIRFIELD
State : IL
Zip : 62837-1218
Country : US
Telephone Number : 618-842-4470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2012
Last Update Date : 05/02/2012

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