Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 71009977A | IN |
N | 363L00000X | Nurse Practitioner | 3014110 | KY |
N | 363L00000X | Nurse Practitioner | 71009977A | IN |
NPI | 1720612096 |
---|---|
Provider Name | Olivia Paige Beam |
First Address | Corydon, IN 47112-2136 |
Second Address | Corydon, IN 47112-2136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300037737 | (05) | IN |
7100663010 | (05) | KY |
71009977A | STATE LICENSE - INDIANA (01) | IN |
ARPN3014110 | STATE LICENSE (01) | KY |
IN3604041 | MEDICARE INDIANA (01) | IN |