Individual
MRS. BEVERLY A SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
925 BEVINS CT, LAKEPORT, CA 95453-9754
(707) 263-8322
(707) 263-0329
Mailing address
925 BEVINS CT, LAKEPORT, CA 95453-9754
(707) 263-8322
(707) 263-0329
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA14213
CA
Other
Enumeration date
12/16/2005
Last updated
09/28/2008
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