Doctor Name: | BEVERLIE HOUSER |
NPI Number: | 1003204660 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | AGPCNP-BC |
License Number: | 4704266184 |
Business Practice Address: | 4190 24th Ave Fort Gratiot, MI - 480593882 |
Business Phone Number: | 8109897788 |
Business Fax Number: | 8109897799 |
Mailing Address: | 4190 24th Ave, FORT GRATIOT |
State: | MI |
Postal Code: | 480593882 |
Phone Number: | 8109897788 |
Fax Number: | 8109897799 |
NPI Enumeration Date: | 01/06/2015 |
NPI Last Update Date: | 01/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | 4704266184 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |