| Doctor Name: | MRS. BEVERLY ANN LEROUX |
| NPI Number: | 1992117568 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 470592-1 |
| Business Practice Address: | 15 Vernon Ave East Norwich, NY - 117321409 |
| Business Phone Number: | 5166247635 |
| Business Fax Number: | |
| Mailing Address: | 15 Vernon Ave, EAST NORWICH |
| State: | NY |
| Postal Code: | 117321409 |
| Phone Number: | 5166247635 |
| Fax Number: | |
| NPI Enumeration Date: | 05/29/2014 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 470592-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |