Provider Demographics
NPI:1417983396
Name:AZEMAR, BEVERLY LYNNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:LYNNE
Last Name:AZEMAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:LYNNE
Other - Last Name:VOLSCKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-5785
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD884936OtherCAREFIRST MD BCBS
PA50059478OtherCAPITAL BLUE CROSS-WMG
PA1568427OtherGATEWAY-WMG
PA203882OtherJOHNS HOPKINS
PAP00409123Medicare PIN
PA203882OtherJOHNS HOPKINS