Healthcare Provider Details

I. General information

NPI: 1417736075
Provider Name (Legal Business Name): FIFTY TWO B.E.A.M.S., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 E 100 N
FOWLER IN
47944-8508
US

IV. Provider business mailing address

PO BOX 52
FOWLER IN
47944-0052
US

V. Phone/Fax

Practice location:
  • Phone: 574-850-0143
  • Fax:
Mailing address:
  • Phone: 574-850-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: REBECCA EILEEN HUMES
Title or Position: CEO
Credential: RN, IBCLC
Phone: 574-850-0143