Individual
DAVITA BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14121 PARKE LONG CT STE 201, CHANTILLY, VA 20151-1647
(513) 223-8748
Mailing address
14121 PARKE LONG CT STE 201, CHANTILLY, VA 20151-1647
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
17346
OH
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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