1417941121 NPI number — MS. BEVERLY A ANDERSON RNCS/APRN-BC

Table of content: MS. BEVERLY A ANDERSON RNCS/APRN-BC (NPI 1417941121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417941121 NPI number — MS. BEVERLY A ANDERSON RNCS/APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
BEVERLY
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNCS/APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417941121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 MARKET SQ
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
AMESBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01913-2497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-388-0606
Provider Business Mailing Address Fax Number:
978-388-0006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MARKET SQ
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
AMESBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01913-2497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-388-0606
Provider Business Practice Location Address Fax Number:
978-388-0006
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0809X , with the licence number:  RNPC 74534 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103995 . This is a "HMO BLUE/MAGELLAN BEHAVIH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1111035 . This is a "MCC/CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 730962 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 177994 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PI 33053 . This is a "PACIFICARE BEHAVIORAL HEA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PN0350 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 010068 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 213220 . This is a "BEACON FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 213220 . This is a "BEACON NEIGHBORHOOD HEALT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 003091 . This is a "HP/ VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S031182 . This is a "CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 010068 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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