Provider Demographics
NPI:1275716623
Name:SWEENEY, BEVERLY (MSN RN-BC PHN CNS)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MSN RN-BC PHN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4005
Mailing Address - Country:US
Mailing Address - Phone:415-292-1344
Mailing Address - Fax:415-292-1344
Practice Address - Street 1:1301 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4005
Practice Address - Country:US
Practice Address - Phone:415-292-1344
Practice Address - Fax:415-292-1344
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615478163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA125716623Medicaid
CA1275716623OtherMEDI CAL
CA1275716623Medicare PIN
CA125716623Medicaid
CA1275716623Medicare UPIN
CA1275716623Medicare Oscar/Certification