Provider Demographics
NPI:1346388642
Name:BEASLEY, MARY (LVN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 S VAN NESS AVE
Mailing Address - Street 2:APT. 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4092
Mailing Address - Country:US
Mailing Address - Phone:415-346-2914
Mailing Address - Fax:
Practice Address - Street 1:1356 S VAN NESS AVE
Practice Address - Street 2:APT. 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4092
Practice Address - Country:US
Practice Address - Phone:415-346-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN120314207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine