Provider Demographics
NPI:1982793188
Name:ROSS, BEVERLY ELAINE (APRN, BC, CNS)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ELAINE
Last Name:ROSS
Suffix:
Gender:F
Credentials:APRN, BC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 MONZA CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3738
Mailing Address - Country:US
Mailing Address - Phone:804-675-5389
Mailing Address - Fax:804-675-5678
Practice Address - Street 1:1201 BROAD ROCK BLVD # 116A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5389
Practice Address - Fax:804-675-5678
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001073251163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult