Provider Demographics
NPI:1902044753
Name:WILSON, BEVERLY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 CUMBERLAND PL
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5083
Mailing Address - Country:US
Mailing Address - Phone:207-990-9000
Mailing Address - Fax:207-941-8645
Practice Address - Street 1:1 CUMBERLAND PL
Practice Address - Street 2:SUITE 108
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5083
Practice Address - Country:US
Practice Address - Phone:207-990-9000
Practice Address - Fax:207-941-8645
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME42487163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health