MEDICARE: CAROL BEALL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	71000655A	IN

General Provider Information

NPI Number	:	1508953076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL BEALL NP

Provider Business Mailing Address
First Line	:	3004 FOREST RIDGE DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-9639
Country	:	US
Telephone Number	:	812-824-7164
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 S WOODSCREST DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5314
Country	:	US
Telephone Number	:	812-353-3333
Fax Number	:	812-323-8528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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