National Provider Identifier
Beverly J Provo, GNPC
Beverly J Provo, GNPC is listed in the NPPES registry with a primary specialty of Family Nurse Practitioner in Newark, NY and a listed phone number of (315) 359-2640.
Profile Overview
- NPI
- 1215096482
- Provider Type
- Individual
- Primary Specialty
- Family Nurse Practitioner
- Enumeration Date
- December 06, 2006
- Last Updated
- January 06, 2011
Practice Location
- 1208 Driving Park Ave
- Newark, NY 14513-1057
Phone: (315) 359-2640
Specialties
- Family Nurse Practitioner (363LF0000X)
- Adult Health Nurse Practitioner (363LA2200X)
Full Record
- NPI
- 1215096482
- Entity Type
- Individual
- Last Name
- Provo
- First Name
- Beverly
- Middle Name
- J
- Credential
- GNPC
- Mailing Street Address
- 1208 Driving Park Ave
- Mailing City
- Newark
- Mailing State
- NY
- Mailing ZIP Code
- 14513-1057
- Mailing Country
- US
- Mailing Phone
- (315) 359-2640
- Practice Street Address
- 1208 Driving Park Ave
- Practice City
- Newark
- Practice State
- NY
- Practice ZIP Code
- 14513-1057
- Practice Country
- US
- Practice Phone
- (315) 359-2640
- Enumeration Date
- December 06, 2006
- Last Updated
- January 06, 2011
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Family Nurse Practitioner (363LF0000X), Adult Health Nurse Practitioner (363LA2200X)