Provider Demographics
NPI:1790092781
Name:BEASLEY, KAMIA MONET (RN)
Entity Type:Individual
Prefix:MISS
First Name:KAMIA
Middle Name:MONET
Last Name:BEASLEY
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 1:3843 S 43RD ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-2180
Mailing Address - Country:US
Mailing Address - Phone:414-810-4597
Mailing Address - Fax:
Practice Address - Street 1:3843 S 43RD ST
Practice Address - Street 2:APT. 1
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-2180
Practice Address - Country:US
Practice Address - Phone:414-810-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304291-031164W00000X
WI195097 - 30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse