Healthcare Provider Details

I. General information

NPI: 1689279994
Provider Name (Legal Business Name): BEVERLEY LAWRENCE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON BLVD STE 100
CRESCENT CITY CA
95531-8161
US

IV. Provider business mailing address

20687 AMAR RD
WALNUT CA
91789-5044
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-6925
  • Fax: 707-387-9808
Mailing address:
  • Phone: 424-332-6459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: