Provider Demographics
NPI:1821201153
Name:BEAVERS, NANCY JEAN
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEAN
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:BEAVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2472 PEARSON WAY
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7767
Mailing Address - Country:US
Mailing Address - Phone:614-456-9068
Mailing Address - Fax:
Practice Address - Street 1:2472 PEARSON WAY
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7767
Practice Address - Country:US
Practice Address - Phone:614-456-9068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-237380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2044246Medicaid