Provider Demographics
NPI:1598220162
Name:MATTHEWS BEACHEM, CATHERINE
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:MATTHEWS BEACHEM
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 1:104 BREAKERS EDGE CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-4508
Mailing Address - Country:US
Mailing Address - Phone:248-298-9714
Mailing Address - Fax:
Practice Address - Street 1:104 BREAKERS EDGE CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4508
Practice Address - Country:US
Practice Address - Phone:248-298-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001215273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse