Provider Demographics
NPI:1891352209
Name:BEUALIEU, JAMES BRENDON
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRENDON
Last Name:BEUALIEU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4701
Mailing Address - Country:US
Mailing Address - Phone:580-678-9227
Mailing Address - Fax:
Practice Address - Street 1:309 S 2ND ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4701
Practice Address - Country:US
Practice Address - Phone:580-678-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307723164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse