Provider Demographics
NPI:1760766307
Name:BEVERLEY, JILL ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:BEVERLEY
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 1:3905 COUNTY ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6272
Mailing Address - Country:US
Mailing Address - Phone:315-727-2642
Mailing Address - Fax:
Practice Address - Street 1:3905 COUNTY ROUTE 6
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6272
Practice Address - Country:US
Practice Address - Phone:315-727-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293379164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse