| Doctor Name: | SALLY BEAVERS |
| NPI Number: | 1548505464 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 200842276RN |
| Business Practice Address: | 29984 Ellensburg Ave Gold Beach, OR - 97444 |
| Business Phone Number: | 5414690405 |
| Business Fax Number: | |
| Mailing Address: | Po Box 434, GOLD BEACH |
| State: | OR |
| Postal Code: | 974440434 |
| Phone Number: | 5414690405 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2012 |
| NPI Last Update Date: | 01/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WW0000X |
| License Number: | 200842276RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Wound Care |
| Taxonomy Definition: | |