Provider Demographics
NPI:1043351448
Name:BEANE, ALICE DIANN (FNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:DIANN
Last Name:BEANE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 LAUCHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352
Mailing Address - Country:US
Mailing Address - Phone:910-277-2999
Mailing Address - Fax:
Practice Address - Street 1:601 LAUCHWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5543
Practice Address - Country:US
Practice Address - Phone:910-299-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC050584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931376Medicaid
31376OtherBLUE CROSS BLUE SHIELD
31376OtherBLUE CROSS BLUE SHIELD
NC8931376Medicaid