1942487285 NPI number — MRS. BEVERLY JEAN RAND RN

Table of content: MRS. BEVERLY JEAN RAND RN (NPI 1942487285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942487285 NPI number — MRS. BEVERLY JEAN RAND RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAND
Provider First Name:
BEVERLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRAZIER
Provider Other First Name:
BEVERLY
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942487285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N8 W31265 CONCORD LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELAFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-646-3126
Provider Business Mailing Address Fax Number:
262-646-3126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 NATIONAL BLVD
Provider Second Line Business Practice Location Address:
ZABLOCKI VAMC
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-384-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2008

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: 163W00000X , with the licence number:  88859030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WC0200X , with the licence number: 88859030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0705X , with the licence number: 8859030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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