Provider Demographics
NPI:1295900884
Name:D'AMICO, BEVERLY (RN)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:REDMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:950 COLLEGE STATION RD
Mailing Address - Street 2:B-36
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2720
Mailing Address - Country:US
Mailing Address - Phone:706-546-3363
Mailing Address - Fax:
Practice Address - Street 1:950 COLLEGE STATION RD
Practice Address - Street 2:B-36
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2720
Practice Address - Country:US
Practice Address - Phone:706-546-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127690163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management