Provider Demographics
NPI:1275819773
Name:THEUER, BEVERLY B (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:B
Last Name:THEUER
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 1:2034 LEHIGH STATION ROAD
Mailing Address - Street 2:RUSH-HENRIETTA CENTRAL SCHOOL DISTRICT
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467
Mailing Address - Country:US
Mailing Address - Phone:585-359-5213
Mailing Address - Fax:585-359-5187
Practice Address - Street 1:1799 LEHIGH STATION ROAD
Practice Address - Street 2:RUSH-HENRIETTA SENIOR HIGH SCHOOL
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467
Practice Address - Country:US
Practice Address - Phone:585-359-5213
Practice Address - Fax:585-359-5187
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255945-1163W00000X, 163WP0807X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent