Healthcare Provider Details

I. General information

NPI: 1508317702
Provider Name (Legal Business Name): ABIGAIL L BEAVER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL L THOMAS CRNA

II. Dates (important events)

Enumeration Date: 10/22/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W LINCOLN AVE
WEST ALLIS WI
53227-2409
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-328-6000
  • Fax: 414-649-1328
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number153064
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: