Provider Demographics
NPI:1912603416
Name:BEARDMORE, JANA DIANE
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:DIANE
Last Name:BEARDMORE
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 1:216 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1001
Mailing Address - Country:US
Mailing Address - Phone:740-336-4086
Mailing Address - Fax:
Practice Address - Street 1:805 FARSON ST STE 112
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1000
Practice Address - Country:US
Practice Address - Phone:740-423-3202
Practice Address - Fax:740-423-3212
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.391983363L00000X
OHAPRN.CNP.0033419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty