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General NPI Number Information
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NPI Number | 1619241007
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Entity Type | Individual
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Provider Name | STACIE MICHELLE BEAVER CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 601 E MAIN ST
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City | WAYNESBORO
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State | PA
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Zip | 17268-2332
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Country | US
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Telephone | 717-765-5088
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Fax | 717-765-5066
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Provider Business Mailing Address
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Address Line | 601 MEMORY LN
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City | YORK
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State | PA
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Zip | 17402-2231
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Country | US
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Telephone | 717-851-1405
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Fax | 717-851-6969
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R139236
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP022183
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License Number State | PA
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