Provider Demographics
NPI:1295015659
Name:BEASLEY, ANTONET RADAWN (LPN)
Entity Type:Individual
Prefix:
First Name:ANTONET
Middle Name:RADAWN
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 E WATERFORD CT
Mailing Address - Street 2:715
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8510
Mailing Address - Country:US
Mailing Address - Phone:419-610-5612
Mailing Address - Fax:
Practice Address - Street 1:1777 E WATERFORD CT
Practice Address - Street 2:715
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8510
Practice Address - Country:US
Practice Address - Phone:419-610-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 143910164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse