Healthcare Provider Details

I. General information

NPI: 1720711344
Provider Name (Legal Business Name): NINA S BEVERLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2539 SPRING CYPRESS RD APT 4301
SPRING TX
77388-5589
US

IV. Provider business mailing address

2539 SPRING CYPRESS RD APT 4301
SPRING TX
77388-5589
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-5918
  • Fax:
Mailing address:
  • Phone: 317-529-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: