Provider Demographics
NPI:1255508818
Name:BAYER, BEVERLY ROSE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ROSE
Last Name:BAYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1756
Mailing Address - Country:US
Mailing Address - Phone:703-264-0521
Mailing Address - Fax:703-860-0229
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 306
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-264-0521
Practice Address - Fax:703-860-0229
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024082738363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner