Healthcare Provider Details

I. General information

NPI: 1942487285
Provider Name (Legal Business Name): BEVERLY JEAN RAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY JEAN FRAZIER LPN

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NATIONAL BLVD ZABLOCKI VAMC
MILWAUKEE WI
53032
US

IV. Provider business mailing address

N8 W31265 CONCORD LANE
DELAFIELD WI
53018
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 262-646-3126
  • Fax: 262-646-3126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number88859030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number88859030
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number8859030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: