BEVERLY PROVO, GNPC

Nurse Practitioner - Family

Active Individual
NPI: 1215096482

Practice Address

1208 DRIVING PARK AVE
Newark, NY 14513

Phone: (315) 359-2640

Specialties

Specialty Code Primary License
Nurse Practitioner - Adult Health 363LA2200X No F3041711 (NY)
Nurse Practitioner - Family 363LF0000X Yes F3403661 (NY)

Frequently Asked Questions

NPI 1215096482 is the National Provider Identifier for BEVERLY PROVO, GNPC, a Nurse Practitioner - Family provider located in Newark, NY. This NPI was enumerated on December 6, 2006.
BEVERLY PROVO, GNPC practices at 1208 DRIVING PARK AVE, Newark, NY 14513.

Quick Facts

NPI
1215096482
Type
Individual
Enumerated
Dec 6, 2006
Last Updated
Jan 6, 2011

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