Healthcare Provider Details

I. General information

NPI: 1902329543
Provider Name (Legal Business Name): ADRIANE BEALS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 SOSA RD
RALEIGH NC
27610-4098
US

IV. Provider business mailing address

PO BOX 784
ZEBULON NC
27597-0784
US

V. Phone/Fax

Practice location:
  • Phone: 919-524-2734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number218107
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: