Healthcare Provider Details

I. General information

NPI: 1982275475
Provider Name (Legal Business Name): BEVERLY SANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13620 38TH AVE STE 6D
FLUSHING NY
11354-4232
US

IV. Provider business mailing address

1530 ALA IOLANI PL
HONOLULU HI
96819-1433
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-108112
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-3878
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: