Healthcare Provider Details

I. General information

NPI: 1902160658
Provider Name (Legal Business Name): ANNFURLY G BEVERLY BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WIND WILLOW WAY BLUEBERRY HILL APT # 9
ROCHESTER NY
14624
US

IV. Provider business mailing address

1600 WIND WILLOW WAY BLUEBERRY HILL APT # 9
ROCHESTER NY
14624
US

V. Phone/Fax

Practice location:
  • Phone: 585-226-1147
  • Fax:
Mailing address:
  • Phone: 585-226-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number628118
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number628118
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: