Provider Demographics
NPI:1417945239
Name:BEYER, BECKY A (MSN, CNS)
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:A
Last Name:BEYER
Suffix:
Gender:F
Credentials:MSN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BAY PARK DR
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4920
Mailing Address - Country:US
Mailing Address - Phone:419-690-8877
Mailing Address - Fax:419-697-4334
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-8877
Practice Address - Fax:419-697-4334
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN176717163W00000X, 163WN0800X
OHCOA.01898-NS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience