Provider Demographics
NPI:1821341322
Name:MILES-WASHINGTON, BEVERLY J
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:J
Last Name:MILES-WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 SAGANASHKEE LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-2400
Mailing Address - Country:US
Mailing Address - Phone:630-904-6323
Mailing Address - Fax:
Practice Address - Street 1:3115 SAGANASHKEE LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-2400
Practice Address - Country:US
Practice Address - Phone:603-291-0327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-001788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL225X00000XOtherHEALTH CARE PROVIDER