=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760684534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLA YVETTE BEASLEY LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14217 WESTROPP
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-486-0870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1720 S GREEN RD
-----------------------------------------------------
City | SOUTH EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-382-0390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN109255
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------