Healthcare Provider Details

I. General information

NPI: 1720443245
Provider Name (Legal Business Name): CAROLYN BEVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 Q ST
OMAHA NE
68127-3272
US

IV. Provider business mailing address

9707 Q ST
OMAHA NE
68127-3272
US

V. Phone/Fax

Practice location:
  • Phone: 800-253-4368
  • Fax:
Mailing address:
  • Phone: 800-253-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111948
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: