Individual
BEATRICE A SUPERVILLE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
219 4TH AVE W, CRESCO, IA 52136-1449
(563) 547-4295
Mailing address
219 4TH AVE W, CRESCO, IA 52136-1449
(563) 547-4295
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
43456
MN
Other
Enumeration date
02/08/2006
Last updated
07/08/2007
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