Healthcare Provider Details

I. General information

NPI: 1407560568
Provider Name (Legal Business Name): ALEXANDER RAY BEAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALCUTTA SQUARE MAIN BUILDING, 15655 OH-170 BLDG, CALCU
EAST LIVERPOOL OH
43920
US

IV. Provider business mailing address

CALCUTTA SQUARE MAIN BUILDING, 15655 OH-170 BLDG, CALCU
EAST LIVERPOOL OH
43920
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax:
Mailing address:
  • Phone: 330-386-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.430956
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: