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General NPI Number Information
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NPI Number | 1548642358
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Entity Type | Individual
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Provider Name | ERIN RENEE BEVERLY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 01/02/2018
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Provider Practice Location Address
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Address Line | 9400 HOLLY AVE NE BLDG 4
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-2969
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Country | US
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Telephone | 505-263-4541
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Fax |
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Provider Business Mailing Address
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Address Line | 12127B HWY 14 N STE 5
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City | CEDAR CREST
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State | NM
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Zip | 87008-9499
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Country | US
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Telephone | 505-281-2460
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Fax | 505-281-2463
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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 | 02729
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License Number State | NM
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