Provider Demographics
NPI:1023018942
Name:UHLENHAKE, BEVERLY J (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:UHLENHAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 UNION CITY RD
Mailing Address - Street 2:PO BOX 635
Mailing Address - City:FT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-9315
Mailing Address - Country:US
Mailing Address - Phone:419-375-4144
Mailing Address - Fax:419-375-4361
Practice Address - Street 1:1830 UNION CITY RD
Practice Address - Street 2:PO 635
Practice Address - City:FT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-9315
Practice Address - Country:US
Practice Address - Phone:419-375-4144
Practice Address - Fax:419-375-4361
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134327Medicaid
OH0234455OtherMEDICAID GROUP
OH9282991OtherMEDICARE GROUP
OHS79370Medicare UPIN
OH0234455OtherMEDICAID GROUP
OHUHNP03001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
OHUHNP03002Medicare PIN