Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | BACB599368 | NE |
NPI | 1003421215 |
---|---|
Provider Name | Andrea Lea Beisner |
First Address | Lewellen, NE 69147-2505 |
Second Address | Gering, NE 69341-3335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |