Provider Demographics
NPI:1295930618
Name:BEAGLE, GEORGIA ANN (LPN)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:ANN
Last Name:BEAGLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 SNYDERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-7523
Mailing Address - Country:US
Mailing Address - Phone:570-275-9410
Mailing Address - Fax:
Practice Address - Street 1:2311 SNYDERTOWN RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-7523
Practice Address - Country:US
Practice Address - Phone:570-275-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN084094L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9410Medicare ID - Type Unspecified