Provider Demographics
NPI:1679629059
Name:KAUFMANN, BEVERLY (CRNA)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 SHERRY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:43910-7970
Mailing Address - Country:US
Mailing Address - Phone:740-264-0130
Mailing Address - Fax:
Practice Address - Street 1:4000 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2300
Practice Address - Country:US
Practice Address - Phone:740-264-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09272-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered