Provider Demographics
NPI:1841822996
Name:SERVICE, BEVERLEY ANN
Entity type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:ANN
Last Name:SERVICE
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 1:2355 MORROW CT NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1763
Mailing Address - Country:US
Mailing Address - Phone:503-364-9015
Mailing Address - Fax:
Practice Address - Street 1:2355 MORROW CT NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1763
Practice Address - Country:US
Practice Address - Phone:503-364-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider