Provider Demographics
NPI:1629265467
Name:BEAVERS, MAE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MAE
Middle Name:
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RAVINE AVE
Mailing Address - Street 2:APT 2B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2170
Mailing Address - Country:US
Mailing Address - Phone:914-966-1495
Mailing Address - Fax:
Practice Address - Street 1:150 RAVINE AVE
Practice Address - Street 2:APT 2B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2170
Practice Address - Country:US
Practice Address - Phone:914-966-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235263-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse