Individual
MARIAH BEADLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1116 MILLIS AVE, BOONVILLE, IN 47601-2204
(812) 897-7404
Mailing address
1116 MILLIS AVE, BOONVILLE, IN 47601-2204
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004581A
IN
Other
Enumeration date
05/21/2024
Last updated
10/17/2024
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