Organization Name: | BEACH CARE PA |
NPI Number: | 1215082540 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AVA MCPHERSON WHITE (PRESIDENT) |
Mailing Address: | 204 D New River Drive Surf City |
State: | NC US |
Postal Code: | 28445 |
Phone Number: | 9103284729 |
Fax Number: | 9103281942 |
NPI Enumeration Date: | 01/25/2007 |
NPI Last Update Date: | 01/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 200319 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |