Healthcare Provider Details

I. General information

NPI: 1548642358
Provider Name (Legal Business Name): ERIN RENEE BEVERLY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 HOLLY AVE NE BLDG 4
ALBUQUERQUE NM
87122-2969
US

IV. Provider business mailing address

12127B HWY 14 N STE 5
CEDAR CREST NM
87008-9499
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-4541
  • Fax:
Mailing address:
  • Phone: 505-281-2460
  • Fax: 505-281-2463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number02729
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: