1902756679 NPI number — MRS. BEVERLY GRANDISON MC, CWP, CHC

Table of content: MRS. BEVERLY GRANDISON MC, CWP, CHC (NPI 1902756679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902756679 NPI number — MRS. BEVERLY GRANDISON MC, CWP, CHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANDISON
Provider First Name:
BEVERLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MC, CWP, CHC
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:
1902756679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 GAINSBOROUGH SQ # G-170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-620-5142
Provider Business Mailing Address Fax Number:
757-436-3832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 MONARCH REACH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-6464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-620-5142
Provider Business Practice Location Address Fax Number:
757-436-3832
Provider Enumeration Date:
02/02/2026

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171400000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com