Individual
BEVERLY EARLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16W472 HONEYSUCKLE ROSE LN APT 112, WILLOWBROOK, IL 60527-6751
(630) 286-3032
Mailing address
16W472 HONEYSUCKLE ROSE LN APT 112, WILLOWBROOK, IL 60527-6751
(630) 286-3032
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-2687491
CRANIAL PROSTHESIS
IL
Enumeration date
01/22/2019
Last updated
01/22/2019
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