MEDICARE: PROF. BEVERLY JO MARIEN RN,CNOR, CRNFA

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	163WR0006X	Registered Nurse First Assistant	123589	MO

General Provider Information

NPI Number	:	1942387592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BEVERLY JO MARIEN RN,CNOR, CRNFA

Provider Business Mailing Address
First Line	:	4400 LINDELL BLVD
Second Line	:	SUITE 21H
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2452
Country	:	US
Telephone Number	:	314-531-1455
Fax Number	:	314-531-1455

Provider Business Practice Location Address
First Line	:	1144 NEW BALLWIN OAKS DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-4472
Country	:	US
Telephone Number	:	636-394-6717
Fax Number	:	636-394-6717

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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