Healthcare Provider Details

I. General information

NPI: 1609069343
Provider Name (Legal Business Name): MS. BEVERLY PILLOW MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W VIRGINIA ST
EVANSVILLE IN
47710-1742
US

IV. Provider business mailing address

2544 OAK BEND PL
NEWBURGH IN
47630-8052
US

V. Phone/Fax

Practice location:
  • Phone: 812-464-7816
  • Fax:
Mailing address:
  • Phone: 812-550-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: