Provider Demographics
NPI:1578602546
Name:HUEGEL, BEVERLY I (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:I
Last Name:HUEGEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 FORRESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2930
Mailing Address - Country:US
Mailing Address - Phone:336-448-9100
Mailing Address - Fax:336-448-5282
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-448-9100
Practice Address - Fax:336-448-5282
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3426363LW0102X, 363LW0102X
NC5014220363LW0102X
PASP009077363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1967Medicaid
SCNP1967Medicaid
SCAA76333922Medicare PIN
PA109948L56Medicare PIN
PAQ78114Medicare UPIN