Provider Demographics
NPI:1225066004
Name:MUSTAIN, BEVERLY (CFNP)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:
Last Name:MUSTAIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10956 DONNER PASS RD
Mailing Address - Street 2:ST 260
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4861
Mailing Address - Country:US
Mailing Address - Phone:530-582-6400
Mailing Address - Fax:530-582-6991
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:ST 260
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-582-6400
Practice Address - Fax:530-582-6991
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZZ0931ZMedicare ID - Type Unspecified
P32767Medicare UPIN