Healthcare Provider Details

I. General information

NPI: 1063431229
Provider Name (Legal Business Name): DONNA SUE BEAUMONT CLINICAL NURSE SPEC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR
ATHENS OH
45701-2301
US

IV. Provider business mailing address

100 HOSPITAL DR
ATHENS OH
45701-2301
US

V. Phone/Fax

Practice location:
  • Phone: 740-589-4136
  • Fax: 740-594-7604
Mailing address:
  • Phone: 740-589-4136
  • Fax: 740-594-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS-04926
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: