Provider Demographics
NPI:1942802897
Name:ADDISON, BEVERLY SUE
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:SUE
Last Name:ADDISON
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 1:3291 LINDALE MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-9793
Mailing Address - Country:US
Mailing Address - Phone:513-491-2757
Mailing Address - Fax:
Practice Address - Street 1:3291 LINDALE MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-9793
Practice Address - Country:US
Practice Address - Phone:513-491-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant