Provider Demographics
NPI:1740026608
Name:BEACON NURSING
Entity type:Organization
Organization Name:BEACON NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:262-723-1758
Mailing Address - Street 1:W5440 ELKHORN DR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-3038
Mailing Address - Country:US
Mailing Address - Phone:262-215-1612
Mailing Address - Fax:
Practice Address - Street 1:W5440 ELKHORN DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-3038
Practice Address - Country:US
Practice Address - Phone:262-215-1612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service