Healthcare Provider Details

I. General information

NPI: 1497834675
Provider Name (Legal Business Name): BETH ELLEN BEERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N METZGER AVE
RITTMAN OH
44270-1017
US

IV. Provider business mailing address

288 N METZGER AVE
RITTMAN OH
44270-1017
US

V. Phone/Fax

Practice location:
  • Phone: 330-925-1243
  • Fax:
Mailing address:
  • Phone: 330-925-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number217170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: