Provider Demographics
NPI:1831414176
Name:DICKENS, BEVERLY JOAN (RN)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JOAN
Last Name:DICKENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 414
Mailing Address - Street 2:BOX 468
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09173-9998
Mailing Address - Country:US
Mailing Address - Phone:962-692-9171
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC BAVARIA
Practice Address - Street 2:CMR 411, BLDG 700, ROSE BARRACKS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:499-662-8347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-8853163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDVAD000Medicare UPIN