Provider Demographics
NPI:1780093450
Name:BEVERLAND, JORDON M (LPN)
Entity type:Individual
Prefix:
First Name:JORDON
Middle Name:M
Last Name:BEVERLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-1144
Mailing Address - Country:US
Mailing Address - Phone:607-434-4724
Mailing Address - Fax:
Practice Address - Street 1:513 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-4643
Practice Address - Country:US
Practice Address - Phone:518-234-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse