Provider Demographics
NPI:1790144293
Name:ROWE, BEVERLY JO
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JO
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BEVERLY
Other - Middle Name:JO
Other - Last Name:ARNECKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-4980
Mailing Address - Fax:203-739-4985
Practice Address - Street 1:41 GERMANTOWN RD
Practice Address - Street 2:SUITE B03
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4087
Practice Address - Country:US
Practice Address - Phone:203-739-4980
Practice Address - Fax:203-739-4985
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered