MEDICARE: MS. BEVERLY ANGELA HARMON 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	514541	NY

General Provider Information

NPI Number	:	1790058063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY ANGELA HARMON RN

Provider Business Mailing Address
First Line	:	2480 8TH AVE APT 4C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7708
Country	:	US
Telephone Number	:	212-690-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 HOLLAND AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-9401
Country	:	US
Telephone Number	:	718-549-6700
Fax Number	:

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

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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