Provider Demographics
NPI:1558696765
Name:VISCUSI, BEVERLY M (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:M
Last Name:VISCUSI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 E YATES RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4944
Mailing Address - Country:US
Mailing Address - Phone:215-245-0156
Mailing Address - Fax:
Practice Address - Street 1:1233 LOCUST ST STE 400
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5459
Practice Address - Country:US
Practice Address - Phone:215-545-8188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP000670D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics