Provider Demographics
NPI:1598839284
Name:MIKE-NARD, BEVERLY J (RNC, MSN, CNNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:MIKE-NARD
Suffix:
Gender:F
Credentials:RNC, MSN, CNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-729-7633
Mailing Address - Fax:330-729-7656
Practice Address - Street 1:8401 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6725
Practice Address - Country:US
Practice Address - Phone:330-729-7633
Practice Address - Fax:330-729-4656
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.04072-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner