Provider Demographics
NPI:1912056581
Name:EARLENBAUGH, BEVERLY ANN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:EARLENBAUGH
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 1:726 EDGEHILL AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4118
Mailing Address - Country:US
Mailing Address - Phone:419-281-7138
Mailing Address - Fax:
Practice Address - Street 1:726 EDGEHILL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4118
Practice Address - Country:US
Practice Address - Phone:419-281-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2637356374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2637356Medicaid