MEDICARE: MS. BEVERLY ANNE SANDERS R.N.

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	163W00000X	Registered Nurse	56237	WV

General Provider Information

NPI Number	:	1841431871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY ANNE SANDERS R.N.

Provider Business Mailing Address
First Line	:	5002 RIDGEMONT HTS
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9771
Country	:	US
Telephone Number	:	304-525-1280
Fax Number	:

Provider Business Practice Location Address
First Line	:	5002 RIDGEMONT HTS
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9771
Country	:	US
Telephone Number	:	304-525-1280
Fax Number	:

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

Provider Enumeration Date	:	03/22/2009
Last Update Date	:	03/22/2009

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