Provider Demographics
NPI:1801429535
Name:DESIMONE, BEVERLY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:DESIMONE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 OLD YORK RD STE E
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-2600
Mailing Address - Country:US
Mailing Address - Phone:215-481-6106
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD YORK RD STE E
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2600
Practice Address - Country:US
Practice Address - Phone:215-481-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA288694L163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant