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NPI Code Detail

MEDICARE: GRACE ELIZABETH BEAUCHAMP

MEDICARE: GRACE ELIZABETH BEAUCHAMP
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
1363LA2200XAdult Health Nurse Practitioner305575NY

General Provider Information

NPI Number : 1992292551
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ELIZABETH BEAUCHAMP
Provider Business Mailing Address
First Line : 7 SWISSTONE ST
Second Line :
City : MEDFORD
State : NY
Zip : 11763-4105
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 636 MIDDLE COUNTRY RD
Second Line :
City : SELDEN
State : NY
Zip : 11784-2500
Country : US
Telephone Number : 631-707-6223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 04/19/2018

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Directions to “ GRACE ELIZABETH BEAUCHAMP ” Practice Location

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