Healthcare Provider Details

I. General information

NPI: 1003458266
Provider Name (Legal Business Name): MARY BEACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 S WASHINGTON RD
SAGINAW MI
48601-4958
US

IV. Provider business mailing address

1602 ELIZABETH ST
MIDLAND MI
48640-4813
US

V. Phone/Fax

Practice location:
  • Phone: 810-356-5556
  • Fax:
Mailing address:
  • Phone: 248-807-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF08190619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: