Provider Demographics
NPI:1497039549
Name:BEAL, VICKI WADSWORTH (CRNP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:WADSWORTH
Last Name:BEAL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:BEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:520 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2538
Mailing Address - Country:US
Mailing Address - Phone:724-527-8060
Mailing Address - Fax:724-522-4002
Practice Address - Street 1:532 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2239
Practice Address - Country:US
Practice Address - Phone:724-832-4450
Practice Address - Fax:724-830-6669
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA229956Medicare PIN