Provider Demographics
NPI:1417283250
Name:BEVERIDGE, LAVINA (APN 0995188)
Entity Type:Individual
Prefix:
First Name:LAVINA
Middle Name:
Last Name:BEVERIDGE
Suffix:
Gender:F
Credentials:APN 0995188
Other - Prefix:
Other - First Name:LAVINA
Other - Middle Name:
Other - Last Name:BEVERIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN 112197
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-1406
Mailing Address - Country:US
Mailing Address - Phone:970-390-8344
Mailing Address - Fax:
Practice Address - Street 1:551 BROADWAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-328-8840
Practice Address - Fax:970-328-8829
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO112197163W00000X
CO0995188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse