Provider Demographics
NPI:1720322142
Name:BEAUVAIS, MARIE MARTHE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:MARTHE
Last Name:BEAUVAIS
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 1:400
Mailing Address - Street 2:LASALLE STREET
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:UM
Mailing Address - Phone:570-317-8923
Mailing Address - Fax:
Practice Address - Street 1:400 LASALLE ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2912
Practice Address - Country:US
Practice Address - Phone:570-317-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN277004374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide