Provider Demographics
NPI:1467672469
Name:BIETENDUVEL, BEVERLY SUE
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:SUE
Last Name:BIETENDUVEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 SCHULTE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-2040
Mailing Address - Country:US
Mailing Address - Phone:513-921-2801
Mailing Address - Fax:
Practice Address - Street 1:4414 SCHULTE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-2040
Practice Address - Country:US
Practice Address - Phone:513-921-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide