Provider Demographics
NPI:1821419839
Name:EASTWOOD, BEVERLY ELAINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ELAINE
Last Name:EASTWOOD
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 1:84 NIGHTENGALE AVENUE
Mailing Address - Street 2:MASSENA CENTRAL SCHOOL DISTRICT
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662
Mailing Address - Country:US
Mailing Address - Phone:315-764-3740
Mailing Address - Fax:315-764-3743
Practice Address - Street 1:25 OWL AVENUE
Practice Address - Street 2:MADISON ELEMENTARY SCHOOL
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662
Practice Address - Country:US
Practice Address - Phone:315-764-3740
Practice Address - Fax:315-764-3743
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454904-1163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool