Provider Demographics
NPI:1497805428
Name:MAYBERRY, BEVERLY MARIE (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:MARIE
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 1ST AVE W
Mailing Address - Street 2:#9
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3451
Mailing Address - Country:US
Mailing Address - Phone:406-262-7282
Mailing Address - Fax:
Practice Address - Street 1:302 4TH AVE
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3654
Practice Address - Country:US
Practice Address - Phone:406-265-5481
Practice Address - Fax:406-265-6976
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily