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General NPI Number Information
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NPI Number | 1215082540
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Entity Type | Organization
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Legal Business Name | BEACH CARE PA
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 204 D NEW RIVER DRIVE
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City | SURF CITY
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State | NC
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Zip | 28445
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Country | US
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Telephone | 910-328-4729
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Fax | 910-328-1942
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Provider Business Mailing Address
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Address Line | PO BOX 2267
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City | SURF CITY
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State | NC
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Zip | 28445-9821
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Country | US
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Telephone | 910-328-4729
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Fax | 910-328-1942
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. AVA MCPHERSON WHITE
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Credential | F.N.P.-C.
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Telephone | 910-328-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200319
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License Number State | NC
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