Provider Demographics
NPI:1265910384
Name:BEACH, JANUARY LEE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:LEE
Last Name:BEACH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JANUARY
Other - Middle Name:L
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1902 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2303
Mailing Address - Country:US
Mailing Address - Phone:220-564-7975
Mailing Address - Fax:220-564-7976
Practice Address - Street 1:1902 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2303
Practice Address - Country:US
Practice Address - Phone:220-564-7975
Practice Address - Fax:220-564-7976
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023351363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307823Medicaid