Provider Demographics
NPI:1922732098
Name:BEAUVAIS, MOZELINE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MOZELINE
Middle Name:
Last Name:BEAUVAIS
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 1:138 DEPEW AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3710
Mailing Address - Country:US
Mailing Address - Phone:845-587-9417
Mailing Address - Fax:
Practice Address - Street 1:138 DEPEW AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3710
Practice Address - Country:US
Practice Address - Phone:845-587-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN690113163W00000X
NJ26NR18123800163W00000X
NY750727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty