Healthcare Provider Details

I. General information

NPI: 1982993796
Provider Name (Legal Business Name): MANDI NICOLE BEUERLEIN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 W MAIN ST
WAVERLY TN
37185-1447
US

IV. Provider business mailing address

2123 TUMMINS RD
MC EWEN TN
37101-4416
US

V. Phone/Fax

Practice location:
  • Phone: 931-296-7000
  • Fax:
Mailing address:
  • Phone: 931-582-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: