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BEVERLY J PROVO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
GNPC

Contact information

Practice address
1208 DRIVING PARK AVE, NEWARK, NY 14513-1057
(315) 359-2640
Mailing address
1208 DRIVING PARK AVE, NEWARK, NY 14513-1057
(315) 359-2640

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
F3041711
NY
363LF0000X
Family Nurse Practitioner
Primary
F3403661
NY

Other

Enumeration date
12/06/2006
Last updated
01/06/2011
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