Provider Demographics
NPI:1518558840
Name:DUTTON, BEVERLY JANE
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JANE
Last Name:DUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19224 PARKMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1708
Mailing Address - Country:US
Mailing Address - Phone:216-526-7998
Mailing Address - Fax:
Practice Address - Street 1:19224 PARKMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1708
Practice Address - Country:US
Practice Address - Phone:216-526-7998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2739540Medicaid