Provider Demographics
NPI:1336299767
Name:BEIERWALTES, PATRICIA SUE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SUE
Last Name:BEIERWALTES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:750 LAKEPOINTE ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1706
Mailing Address - Country:US
Mailing Address - Phone:313-745-0396
Mailing Address - Fax:313-745-2405
Practice Address - Street 1:CHILDREN'S HOSPITAL OF MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN BLVD.
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5226
Practice Address - Fax:313-745-2405
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704139472363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics