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General NPI Number Information
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NPI Number | 1417561937
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Entity Type | Individual
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Provider Name | CHRISTOPHER BEARDSLEY FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 1281 MARINETTE AVE
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City | MARINETTE
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State | WI
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Zip | 54143-2018
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Country | US
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Telephone | 715-330-7090
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Fax | 715-732-0828
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Provider Business Mailing Address
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Address Line | PO BOX 22487
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City | GREEN BAY
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State | WI
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Zip | 54305-2487
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Country | US
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Telephone | 715-330-7090
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Fax | 715-732-0828
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10307-33
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License Number State | WI
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