Healthcare Provider Details

I. General information

NPI: 1528546769
Provider Name (Legal Business Name): BEVERLY LAAS DROST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 BERGER RD
VICTORIA TX
77905-5208
US

IV. Provider business mailing address

8016 STATE HIGHWAY 111 E
YOAKUM TX
77995-5377
US

V. Phone/Fax

Practice location:
  • Phone: 361-550-8856
  • Fax:
Mailing address:
  • Phone: 361-293-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number241914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: