Provider Demographics
NPI:1235803743
Name:PETERS, BEVERLY ROSE (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ROSE
Last Name:PETERS
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 CAMARGO RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-3107
Mailing Address - Country:US
Mailing Address - Phone:513-528-8150
Mailing Address - Fax:
Practice Address - Street 1:7625 CAMARGO RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-3107
Practice Address - Country:US
Practice Address - Phone:513-528-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00037799363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care