Individual
MAURA T BEARDSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
(920) 430-4889
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3456-23
WI
363A00000X
Physician Assistant
Primary
5601008327
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1112310
NCCPA
—
Enumeration date
10/14/2014
Last updated
02/06/2024
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