Provider Demographics
NPI:1255743332
Name:LAMMERS, BEVERLY ANN
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:LAMMERS
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:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-0773
Mailing Address - Country:US
Mailing Address - Phone:208-324-2004
Mailing Address - Fax:208-324-1154
Practice Address - Street 1:133 WEST AVE A, ST. B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3392
Practice Address - Country:US
Practice Address - Phone:208-324-2004
Practice Address - Fax:208-324-1154
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1413A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily