Provider Demographics
NPI:1043284441
Name:STEELE, BEVERLY (CN-P)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:CN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 INDUSTRIAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1246
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:800 M-139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4843
Practice Address - Country:US
Practice Address - Phone:269-927-5400
Practice Address - Fax:269-927-5493
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704111765367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI467440810Medicaid
MI467440810Medicaid
MIQ06732Medicare UPIN