Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1-102818 | AL |
NPI | 1043600729 |
---|---|
Provider Name | Ms. Joan E Beasley |
First Address | Birmingham, AL 35242-8642 |
Second Address | Birmingham, AL 35213-1908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |