Provider Demographics
NPI:1649465360
Name:BEARDT, ESTHER LORRAINE (LPN)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:LORRAINE
Last Name:BEARDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:LORRAINE
Other - Last Name:VONDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4036 W GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3027
Mailing Address - Country:US
Mailing Address - Phone:602-770-2626
Mailing Address - Fax:602-978-6253
Practice Address - Street 1:711 E MISSOURI AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2824
Practice Address - Country:US
Practice Address - Phone:602-433-1200
Practice Address - Fax:602-604-9690
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP021715164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse