Provider Demographics
NPI:1033350988
Name:BEYER, GWEN BALENTINE (RN)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:BALENTINE
Last Name:BEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 POTTER ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2776
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5434 POTTER ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2776
Practice Address - Country:US
Practice Address - Phone:941-914-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9221927163W00000X
CORN187991163W00000X
SDR036813163W00000X
MI4704258249163W00000X
AKNUR R 26451163W00000X
NC214990163W00000X
KS102944163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse