Healthcare Provider Details

I. General information

NPI: 1730245044
Provider Name (Legal Business Name): PATRICIA JENNIE BEVERLY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CHANDLER AVENUE
BATAVIA NY
14020-1649
US

IV. Provider business mailing address

33 CHANDLER AVENUE
BATAVIA NY
14020-1649
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-4700
  • Fax: 585-345-4191
Mailing address:
  • Phone: 585-344-4700
  • Fax: 585-345-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420625-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF000608
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number300227-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: