Provider Demographics
NPI:1013411503
Name:HOUSE, BEVERLEY ANN
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:ANN
Last Name:HOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 WHITAKER LN
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3510
Mailing Address - Country:US
Mailing Address - Phone:775-423-6151
Mailing Address - Fax:
Practice Address - Street 1:890 WHITAKER LN
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3510
Practice Address - Country:US
Practice Address - Phone:775-423-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health