Healthcare Provider Details

I. General information

NPI: 1396790184
Provider Name (Legal Business Name): BEVERLY WRAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 S GRANDE BLVD
GREENSBURG PA
15601-8902
US

IV. Provider business mailing address

506 ATHENA DR
DELMONT PA
15626-1005
US

V. Phone/Fax

Practice location:
  • Phone: 724-830-4000
  • Fax:
Mailing address:
  • Phone: 724-468-6869
  • Fax: 724-468-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP005032B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: