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General NPI Number Information
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NPI Number | 1952845109
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Entity Type | Organization
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Legal Business Name | GLORIA M BEERY, CNP
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | 1545 E LEIGHFIELD DR SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-5371
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Country | US
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Telephone | 208-855-2710
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 E LEIGHFIELD DR SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-5371
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Country | US
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Telephone | 208-855-2710
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATHLEEN LEWIS
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Credential |
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Telephone | 208-955-8215
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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 | NP122A
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License Number State | ID
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