Healthcare Provider Details

I. General information

NPI: 1326000605
Provider Name (Legal Business Name): BEVERLY ANNE GILRAINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BLVD 1970 ROANOKE BLVD
SALEM VA
24153-6404
US

IV. Provider business mailing address

1338 PULASKI ST
SALEM VA
24153-5511
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-855-3458
Mailing address:
  • Phone: 540-387-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number001154072
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0017001387
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024154072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: