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General NPI Number Information
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NPI Number | 1922313824
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Entity Type | Individual
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Provider Name | BEVERLY ANN NUCHOLS ANP, PHD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 20103 LAKE CHABOT RD EDEN MEDICAL CENTER EMPLOYEE HEALTH CLINIC
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5305
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Country | US
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Telephone | 510-889-5067
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Fax | 510-537-1443
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Provider Business Mailing Address
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Address Line | 20103 LAKE CHABOT RD EDEN MEDICAL CENTER EMPLOYEE HEALTH CLINIC
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5305
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Country | US
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Telephone | 510-889-5067
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Fax | 510-537-1443
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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 | 257198
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License Number State | CA
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