Provider Demographics
NPI:1659681336
Name:HALL-CLARKE, BEVERLY (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:HALL-CLARKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 OCEAN AVE
Mailing Address - Street 2:APT-1P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1754
Mailing Address - Country:US
Mailing Address - Phone:718-671-2100
Mailing Address - Fax:
Practice Address - Street 1:395 OCEAN AVE
Practice Address - Street 2:APT-1P
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1754
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY636066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse